Provider Demographics
NPI:1427803683
Name:SCHMIDT, CONNOR JACOB (DO)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:JACOB
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 1:2322 S HIGHVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3249
Mailing Address - Country:US
Mailing Address - Phone:319-215-7408
Mailing Address - Fax:
Practice Address - Street 1:2322 S HIGHVIEW AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3249
Practice Address - Country:US
Practice Address - Phone:319-215-7408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program