Provider Demographics
NPI:1215919014
Name:SCHNEIDER, EDWARD (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:SCHNEIDER
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 1:1017 W LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-2515
Mailing Address - Country:US
Mailing Address - Phone:209-951-3945
Mailing Address - Fax:209-954-9205
Practice Address - Street 1:1017 W LINCOLN RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-2515
Practice Address - Country:US
Practice Address - Phone:209-951-3945
Practice Address - Fax:209-954-9205
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20679207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G206790Medicaid
CA00G206790Medicare ID - Type Unspecified
CA00G206790Medicaid