Provider Demographics
NPI:1831160712
Name:SCHNEIDER, DORAN JAMES (DO)
Entity type:Individual
Prefix:
First Name:DORAN
Middle Name:JAMES
Last Name:SCHNEIDER
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 1:1490 E FOREMASTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4496
Mailing Address - Country:US
Mailing Address - Phone:435-628-1641
Mailing Address - Fax:877-588-3498
Practice Address - Street 1:1490 E FOREMASTER DR STE 200
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4496
Practice Address - Country:US
Practice Address - Phone:435-628-1641
Practice Address - Fax:877-588-3498
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8058398-1204208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ928179Medicare ID - Type UnspecifiedAHCCCS
H44134Medicare UPIN
103386Medicare ID - Type Unspecified