Healthcare Provider Details

I. General information

NPI: 1912997230
Provider Name (Legal Business Name): GEORGE E SCHOEPHOERSTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIR
SAINT CLOUD MN
56303-5000
US

IV. Provider business mailing address

3366 OAKDALE AVENUE NORTH SUITE 315
ROBINSDALE MN
55422
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-4917
  • Fax: 320-229-5181
Mailing address:
  • Phone: 763-587-7900
  • Fax: 763-587-7989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27065
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number27065
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: