Provider Demographics
NPI:1124343512
Name:SCHROEDER, JONATHAN RYAN (DO)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:RYAN
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1876 NIGHTINGALE LN
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4359
Mailing Address - Country:US
Mailing Address - Phone:352-742-4447
Mailing Address - Fax:352-742-4448
Practice Address - Street 1:1876 NIGHTINGALE LN
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4359
Practice Address - Country:US
Practice Address - Phone:352-742-4447
Practice Address - Fax:352-742-4448
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12192207RC0200X, 207RP1001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009900300Medicaid