Provider Demographics
NPI:1306885165
Name:SCHMID, PETER MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:MICHAEL
Last Name:SCHMID
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 1:1305 SUMNER STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3270
Mailing Address - Country:US
Mailing Address - Phone:303-651-6846
Mailing Address - Fax:303-651-6794
Practice Address - Street 1:1305 SUMNER STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3270
Practice Address - Country:US
Practice Address - Phone:303-651-6846
Practice Address - Fax:303-651-6794
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32368207Y00000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01323682Medicaid
CO01323682Medicaid
E93634Medicare UPIN