Healthcare Provider Details

I. General information

NPI: 1649654054
Provider Name (Legal Business Name): JULIE SCHOMMER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S EAGLE RD STE 1234
MERIDIAN ID
83642-6355
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-429-0300
  • Fax: 208-429-0305
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberO-1835
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: