Provider Demographics
NPI:1932190071
Name:SCHUMAN, EARL S (MD)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:S
Last Name:SCHUMAN
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 1:1130 NW 22ND AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2970
Mailing Address - Country:US
Mailing Address - Phone:503-226-4325
Mailing Address - Fax:503-227-5024
Practice Address - Street 1:1130 NW 22ND AVE
Practice Address - Street 2:STE 300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2970
Practice Address - Country:US
Practice Address - Phone:503-226-4325
Practice Address - Fax:503-227-5024
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09039208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD09039OtherSTATE LICENSE NUMBER
OR217729Medicaid
OR00WCGJKBMedicare ID - Type Unspecified
C90967Medicare UPIN