Provider Demographics
NPI:1982705158
Name:SCHMIDT, DIETER KURT THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:DIETER
Middle Name:KURT THOMAS
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1793 13TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2541
Mailing Address - Country:US
Mailing Address - Phone:971-273-1024
Mailing Address - Fax:503-362-8435
Practice Address - Street 1:15906 MILL CREEK BLVD
Practice Address - Street 2:STE 105
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1603
Practice Address - Country:US
Practice Address - Phone:425-385-2009
Practice Address - Fax:425-939-0807
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044310207N00000X, 207ND0900X, 207NP0225X, 207NS0135X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAI37017Medicare UPIN
WAG8875082Medicare PIN