Provider Demographics
NPI:1215938543
Name:SCHMIDT, RAEDENE (MD)
Entity type:Individual
Prefix:
First Name:RAEDENE
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2748 CROSSROADS BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-3933
Mailing Address - Country:US
Mailing Address - Phone:970-255-0919
Mailing Address - Fax:970-255-0901
Practice Address - Street 1:2748 CROSSROADS BLVD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-3933
Practice Address - Country:US
Practice Address - Phone:970-255-0919
Practice Address - Fax:970-255-0901
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-10-24
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
CO19581207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COSC80491OtherBCBS
CO01195817Medicaid
CO80491Medicare ID - Type Unspecified
COSC80491OtherBCBS