Provider Demographics
NPI:1528083003
Name:SCHOENFELD, ROGER HAROLD (DO)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:HAROLD
Last Name:SCHOENFELD
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:PO BOX 2220
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2220
Mailing Address - Country:US
Mailing Address - Phone:417-781-7220
Mailing Address - Fax:417-781-5512
Practice Address - Street 1:2709 W 13TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-3663
Practice Address - Country:US
Practice Address - Phone:417-781-2220
Practice Address - Fax:417-781-5512
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7136208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO241978808Medicaid
KS100229850DMedicaid
OK100184950AMedicaid
MA4695OtherMEDICARE GROUP PTAN
MA4695001OtherMEDICARE PROVIDER PTAN
1962834390OtherGROUP NPI
1962834390OtherGROUP NPI
MOMA2082204Medicare PIN