Provider Demographics
NPI:1215936455
Name:SCHMIDT, JAY M (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:M
Last Name:SCHMIDT
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 1:115 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GRACEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56240-4803
Mailing Address - Country:US
Mailing Address - Phone:320-748-7243
Mailing Address - Fax:320-748-8204
Practice Address - Street 1:115 W 2ND ST
Practice Address - Street 2:
Practice Address - City:GRACEVILLE
Practice Address - State:MN
Practice Address - Zip Code:56240-4803
Practice Address - Country:US
Practice Address - Phone:320-748-7243
Practice Address - Fax:320-748-8204
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN812980100Medicaid
MN166K7SCOtherBLUE CROSS BLUE SHIELD MN
MN52264Medicare UPIN
MN080012824Medicare ID - Type Unspecified