Provider Demographics
NPI:1922254531
Name:SCHNEIDER, GARY M (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:M
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 FENWICK CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7783
Mailing Address - Country:US
Mailing Address - Phone:205-807-4279
Mailing Address - Fax:209-290-3015
Practice Address - Street 1:125 FENWICK CIR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7783
Practice Address - Country:US
Practice Address - Phone:205-807-4279
Practice Address - Fax:209-290-3015
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101025823207R00000X
AK163395207R00000X
MS21564207R00000X
OH34.00974207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine