Provider Demographics
NPI:1528077013
Name:SCHOONOVER, EDWIN DALE (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:DALE
Last Name:SCHOONOVER
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 1:501 DAWSON RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND FURNACE
Mailing Address - State:TN
Mailing Address - Zip Code:37051-9001
Mailing Address - Country:US
Mailing Address - Phone:931-387-3730
Mailing Address - Fax:931-387-4843
Practice Address - Street 1:1731 MEMORIAL DR
Practice Address - Street 2:SUITE 110
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4523
Practice Address - Country:US
Practice Address - Phone:931-221-2179
Practice Address - Fax:931-221-2173
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD17602207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE43152Medicare UPIN