Provider Demographics
NPI:1699765149
Name:SCHNEIDER, THOMAS RUSSELL (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RUSSELL
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 N DAVIS HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2724
Mailing Address - Country:US
Mailing Address - Phone:850-477-8500
Mailing Address - Fax:850-477-8600
Practice Address - Street 1:4501 N DAVIS HWY
Practice Address - Street 2:SUITE C
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2724
Practice Address - Country:US
Practice Address - Phone:850-477-8500
Practice Address - Fax:850-477-8600
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51893174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044650500Medicaid
FL044650500Medicaid
FLE75802Medicare UPIN