Provider Demographics
NPI:1841467925
Name:SCHMAELZLE, JOHN FAIR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FAIR
Last Name:SCHMAELZLE
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 1:2490 HOSPITAL DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4122
Mailing Address - Country:US
Mailing Address - Phone:650-962-4662
Mailing Address - Fax:
Practice Address - Street 1:2490 HOSPITAL DR
Practice Address - Street 2:SUITE 210
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4122
Practice Address - Country:US
Practice Address - Phone:650-962-4662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA21301208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A213010OtherBLUE SHIELD
CA00A213010OtherMEDI-CAL
CAA22558Medicare UPIN
CA00A213010Medicare PIN