Provider Demographics
NPI:1114599313
Name:SCHMIDT, SCOTT C (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5926 MARETA LN
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-9556
Mailing Address - Country:US
Mailing Address - Phone:916-741-1214
Mailing Address - Fax:
Practice Address - Street 1:13555 BOWMAN RD STE 100
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3197
Practice Address - Country:US
Practice Address - Phone:308-853-9515
Practice Address - Fax:530-885-3932
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A22156207Q00000X
WAOL61191776390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine