Provider Demographics
NPI:1891759676
Name:SCHROEDER, JAMES GARY (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GARY
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 WESTWAY AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-3728
Mailing Address - Country:US
Mailing Address - Phone:214-693-8134
Mailing Address - Fax:
Practice Address - Street 1:4320 WESTWAY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3728
Practice Address - Country:US
Practice Address - Phone:214-693-8134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ45032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047354801Medicaid
TX132136605Medicaid
TX88R249Medicare PIN
F72522Medicare UPIN
TX047354801Medicaid