Healthcare Provider Details

I. General information

NPI: 1124343512
Provider Name (Legal Business Name): JONATHAN RYAN SCHROEDER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 N KENTUCKY AVE
WINTER PARK FL
32789-4741
US

IV. Provider business mailing address

1110 N KENTUCKY AVE
WINTER PARK FL
32789-4741
US

V. Phone/Fax

Practice location:
  • Phone: 407-539-2766
  • Fax: 407-539-2786
Mailing address:
  • Phone: 407-539-2766
  • Fax: 407-539-2786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberOS12192
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberOS12192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: