Provider Demographics
NPI:1912997230
Name:SCHOEPHOERSTER, GEORGE E (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:E
Last Name:SCHOEPHOERSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3366 OAKDALE AVENUE NORTH
Mailing Address - Street 2:SUITE 315
Mailing Address - City:ROBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:763-587-7900
Mailing Address - Fax:763-587-7989
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-4917
Practice Address - Fax:320-229-5181
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27065207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
203LISCOtherBCBS
0116867OtherMEDICA HEALTH PLANS
00438506OtherPREFERRED ONE
HP26264OtherHEALTH PARTNERS
135308000OtherMEDICAL ASSISTANCE
MN135308000Medicaid
110853OtherU CARE
797925OtherARAZ GROUP AMERICAS PPO
080013049Medicare ID - Type Unspecified
0116867OtherMEDICA HEALTH PLANS