Healthcare Provider Details

I. General information

NPI: 1457304651
Provider Name (Legal Business Name): PAUL G SCHMITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 DELMAR BLVD
SAINT LOUIS MO
63112-3005
US

IV. Provider business mailing address

5535 DELMAR BLVD
SAINT LOUIS MO
63112-3005
US

V. Phone/Fax

Practice location:
  • Phone: 314-879-6363
  • Fax: 314-879-6486
Mailing address:
  • Phone: 314-879-6363
  • Fax: 314-879-6486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberR7N19
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: