Provider Demographics
NPI:1245252444
Name:SCHMIDT, PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:SCHMIDT
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 1:725 W GRANADA BLVD
Mailing Address - Street 2:SUITE 22
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174
Mailing Address - Country:US
Mailing Address - Phone:386-788-2300
Mailing Address - Fax:386-944-6622
Practice Address - Street 1:725 W GRANADA BLVD
Practice Address - Street 2:SUITE 22
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-788-2300
Practice Address - Fax:386-944-6622
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA064069002084N0400X
FLME762672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273413300Medicaid
FL0172537OtherGHI
FL16390PMedicare PIN
FL0172537OtherGHI
FL16390QMedicare PIN
FLF94745Medicare UPIN