Provider Demographics
NPI:1336186972
Name:SCHOMER, DONALD (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:SCHOMER
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:PO BOX 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4000
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO405952085R0202X
AZ452302085R0202X
TXH46812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200425460AMedicaid
CO300131539OtherRR RIA MCRE
AKMD465COMedicaid
CO300131538OtherRR DIA MCRE
NE84-059792913Medicaid
NM88688038Medicaid
CO300131540OtherRR MIC MCRE
CO82585822Medicaid
NEP00720368OtherRR MCR NE
SD1336186972Medicaid
TX132224007Medicaid
NE10025709000Medicaid
MT1336186972Medicaid
WY1336186972Medicaid
MI104699470Medicaid
UT1679513196Medicaid
NENA1214023Medicare PIN
AKMD465COMedicaid
NE84-059792913Medicaid
TX440511YKQHMedicare PIN
CO300131540OtherRR MIC MCRE
UT1679513196Medicaid
NE10025709000Medicaid
TX132224007Medicaid
COC463018Medicare PIN