Provider Demographics
NPI:1134422389
Name:MARK E. SCHROEDER M.D.PA
Entity type:Organization
Organization Name:MARK E. SCHROEDER M.D.PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:8506783994
Authorized Official - Phone:850-678-3994
Mailing Address - Street 1:1005 COLLEGE BLVD W
Mailing Address - Street 2:SUITE C
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1053
Mailing Address - Country:US
Mailing Address - Phone:850-678-3994
Mailing Address - Fax:850-678-7131
Practice Address - Street 1:1005 COLLEGE BLVD W
Practice Address - Street 2:SUITE C
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1053
Practice Address - Country:US
Practice Address - Phone:850-678-3994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69073207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty