Provider Demographics
NPI:1699876854
Name:SCHOENROCK, GARY J (MD)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:J
Last Name:SCHOENROCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE DEPT 358
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8004
Mailing Address - Country:US
Mailing Address - Phone:907-225-2255
Mailing Address - Fax:907-228-8496
Practice Address - Street 1:3100 TONGASS AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5746
Practice Address - Country:US
Practice Address - Phone:907-225-5237
Practice Address - Fax:907-228-8496
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00025207208800000X
AKMD2316208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD23162Medicaid
AKMD23162Medicaid
AKK161059Medicare PIN