Healthcare Provider Details

I. General information

NPI: 1265530760
Provider Name (Legal Business Name): GEORGE SCHROEDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 STERTHAUS DR
ORMOND BEACH FL
32174-5130
US

IV. Provider business mailing address

700 STERTHAUS DR
ORMOND BEACH FL
32174-5130
US

V. Phone/Fax

Practice location:
  • Phone: 386-301-4067
  • Fax:
Mailing address:
  • Phone: 386-301-4071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberME102872
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: