Provider Demographics
NPI:1922128602
Name:SCHROEDER, CLAYTON BATES (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:BATES
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11819 MIRACLE HILLS DR STE 105
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4428
Mailing Address - Country:US
Mailing Address - Phone:402-356-8601
Mailing Address - Fax:402-819-0919
Practice Address - Street 1:11819 MIRACLE HILLS DR STE 105
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4428
Practice Address - Country:US
Practice Address - Phone:402-356-8601
Practice Address - Fax:402-819-0919
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24294207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10027852400Medicaid
NE47068731798Medicaid
NE099099018Medicare PIN