Healthcare Provider Details

I. General information

NPI: 1346229010
Provider Name (Legal Business Name): AMY R SCHOMER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 W LIBERTY ST
FARMINGTON MO
63640-1921
US

IV. Provider business mailing address

1103 W LIBERTY ST
FARMINGTON MO
63640-1921
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-6751
  • Fax:
Mailing address:
  • Phone: 573-756-6751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26803
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24652
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2016021528
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: