Provider Demographics
NPI:1104077445
Name:SCHNEIDER, JASON LEE (IDC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:LEE
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 SEABEE DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23521-2917
Mailing Address - Country:US
Mailing Address - Phone:757-462-8710
Mailing Address - Fax:
Practice Address - Street 1:1815 SEABEE DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23521-2917
Practice Address - Country:US
Practice Address - Phone:757-462-8710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman