Provider Demographics
NPI:1831157916
Name:SCHUMANN, RICHARD J JR (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:SCHUMANN
Suffix:JR
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 1770
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91944-1770
Mailing Address - Country:US
Mailing Address - Phone:619-464-1165
Mailing Address - Fax:619-567-1011
Practice Address - Street 1:16776 BERNARDO CENTER DR
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2669
Practice Address - Country:US
Practice Address - Phone:858-675-1112
Practice Address - Fax:858-675-1141
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA623242084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409372100Medicaid
CAA62324OtherCALIFORNIA MED LICENSE
MDDA4922OtherMEDICARE RAILROAD
DEDB8776OtherMEDICARE RAILROAD
CA413MN330Medicare PIN
DEDB8776OtherMEDICARE RAILROAD
MDDA4922OtherMEDICARE RAILROAD
CAG91475Medicare UPIN
MD413MN330Medicare PIN