Provider Demographics
NPI:1952423121
Name:SCHROEDER, EDMUND JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:
Last Name:SCHROEDER
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 8838
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-8838
Mailing Address - Country:US
Mailing Address - Phone:671-647-5355
Mailing Address - Fax:671-647-5358
Practice Address - Street 1:655 HARMON LOOP RD STE 300
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-6544
Practice Address - Country:US
Practice Address - Phone:671-647-5355
Practice Address - Fax:671-647-5358
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-819207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUH57386Medicare ID - Type Unspecified
GUCC466YMedicare Oscar/Certification
GUD43494Medicare UPIN