Healthcare Provider Details

I. General information

NPI: 1801849252
Provider Name (Legal Business Name): PAUL WILLIAM SCHOEPHOERSTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 E BROADWAY STE 110
COLUMBIA MO
65201-8023
US

IV. Provider business mailing address

1605 E BROADWAY STE 110
COLUMBIA MO
65201-8023
US

V. Phone/Fax

Practice location:
  • Phone: 573-815-8130
  • Fax: 573-815-8149
Mailing address:
  • Phone: 573-815-8130
  • Fax: 573-815-8149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMDR4N39
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: