Provider Demographics
NPI:1740285170
Name:SCHADER, JAMES B (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:SCHADER
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 1:19875 SW 65TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8353
Mailing Address - Country:US
Mailing Address - Phone:503-692-3250
Mailing Address - Fax:503-691-2212
Practice Address - Street 1:19875 SW 65TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8353
Practice Address - Country:US
Practice Address - Phone:503-692-3250
Practice Address - Fax:503-691-2212
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13240174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR215731Medicaid
OR215731Medicaid
OR135625Medicare PIN