Provider Demographics
NPI:1700870375
Name:SCHNEIDER, RICKY MARC (MD)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:MARC
Last Name:SCHNEIDER
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 1:7710 NW 71ST CT STE 303
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2932
Mailing Address - Country:US
Mailing Address - Phone:954-303-0225
Mailing Address - Fax:305-675-2796
Practice Address - Street 1:7710 NW 71ST CT STE 303
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2932
Practice Address - Country:US
Practice Address - Phone:954-303-0225
Practice Address - Fax:305-675-2796
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047659207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374917700Medicaid
FL94628Medicare PIN
FL374917700Medicaid