Provider Demographics
NPI:1356360358
Name:SCHROEDER, DAVID W (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:SCHROEDER
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 1:5965 GREENBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-9280
Mailing Address - Country:US
Mailing Address - Phone:615-394-0797
Mailing Address - Fax:
Practice Address - Street 1:5965 GREENBRIAR RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-9280
Practice Address - Country:US
Practice Address - Phone:615-394-0797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003016373207PE0004X
HIMD10372207PE0004X
KY47396207P00000X
TN29497207P00000X
WV21265207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100641870AMedicaid
MO208403006Medicaid
MO208403006Medicaid
B46C436BMedicare ID - Type Unspecified