Provider Demographics
NPI:1932157013
Name:SCHRADER, SARA B (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:B
Last Name:SCHRADER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 BELLEWETHER PASS
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-8758
Mailing Address - Country:US
Mailing Address - Phone:601-605-0459
Mailing Address - Fax:
Practice Address - Street 1:1813 HIGHWAY 61 N
Practice Address - Street 2:
Practice Address - City:TUNICA
Practice Address - State:MS
Practice Address - Zip Code:38676-9683
Practice Address - Country:US
Practice Address - Phone:662-357-0012
Practice Address - Fax:662-357-0021
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28505207P00000X
MS10788207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1162515Medicaid
TN3883873Medicaid
MS00126344Medicaid
TN3883873Medicaid
LA1162515Medicaid
MS080004088Medicare PIN
TN3730669Medicare ID - Type Unspecified