Provider Demographics
NPI:1962412353
Name:SCHNEIDER, STEPHEN D (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:D
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 W. CITRACADO PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6428
Mailing Address - Country:US
Mailing Address - Phone:760-746-2641
Mailing Address - Fax:760-740-2178
Practice Address - Street 1:625 W. CITRACADO PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6428
Practice Address - Country:US
Practice Address - Phone:760-746-2641
Practice Address - Fax:760-740-2178
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3245581205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005530422Medicare PIN
UTG30883Medicare UPIN