Provider Demographics
NPI:1265542476
Name:FRED W. SCHNEPPER, MD, INC.
Entity type:Organization
Organization Name:FRED W. SCHNEPPER, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:SCHNEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-482-2400
Mailing Address - Street 1:750 MEDICAL CENTER CT STE 8
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6634
Mailing Address - Country:US
Mailing Address - Phone:619-482-2400
Mailing Address - Fax:619-482-2411
Practice Address - Street 1:750 MEDICAL CENTER COURT #8
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6634
Practice Address - Country:US
Practice Address - Phone:619-482-2400
Practice Address - Fax:619-482-2411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRED W. SCHNEPPER, MD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG7025174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G70250Medicaid
CA000G70250Medicaid
CAW22314Medicare PIN