Healthcare Provider Details

I. General information

NPI: 1306846746
Provider Name (Legal Business Name): JOHN JOSEPH SCHMIDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W 17TH ST
PUEBLO CO
81003-2622
US

IV. Provider business mailing address

509 W 17TH ST
PUEBLO CO
81003-2622
US

V. Phone/Fax

Practice location:
  • Phone: 719-543-2211
  • Fax: 719-584-4779
Mailing address:
  • Phone: 719-543-2211
  • Fax: 719-584-4779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number26193
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number26193
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number26193
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: