Healthcare Provider Details

I. General information

NPI: 1396829347
Provider Name (Legal Business Name): MARY E. SCHMIEDER DO. FACEP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1543 KINGSLEY AVE
ORANGE PARK FL
32073-4535
US

IV. Provider business mailing address

PO BOX 14379
JACKSONVILLE FL
32238-1379
US

V. Phone/Fax

Practice location:
  • Phone: 904-278-2246
  • Fax:
Mailing address:
  • Phone: 904-278-2246
  • Fax: 904-278-2247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberOS0004991
License Number StateFL

VIII. Authorized Official

Name: DR. MARY E SCHMIEDER
Title or Position: DOCTOR
Credential: D.O.
Phone: 904-278-2246