Provider Demographics
NPI:1528160934
Name:WILLIAM R SCHROEDER DO PC
Entity type:Organization
Organization Name:WILLIAM R SCHROEDER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-686-0032
Mailing Address - Street 1:PO BOX 5319
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80866-5319
Mailing Address - Country:US
Mailing Address - Phone:719-686-0032
Mailing Address - Fax:719-687-8785
Practice Address - Street 1:400 WEST MIDLAND AVE
Practice Address - Street 2:STE 155
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863
Practice Address - Country:US
Practice Address - Phone:719-686-0032
Practice Address - Fax:719-687-8785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60707321Medicaid
F62784Medicare UPIN
CO60707321Medicaid