Healthcare Provider Details

I. General information

NPI: 1639243884
Provider Name (Legal Business Name): WILLIAM TRACY SCHMIDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 E MAIN ST
STAMFORD CT
06902-3544
US

IV. Provider business mailing address

1281 E MAIN ST
STAMFORD CT
06902-3544
US

V. Phone/Fax

Practice location:
  • Phone: 203-325-4087
  • Fax: 203-359-9941
Mailing address:
  • Phone: 203-325-4087
  • Fax: 203-359-9941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number028197
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number028197
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number028197
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number028197
License Number StateCT
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number028197
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: