Healthcare Provider Details

I. General information

NPI: 1598087652
Provider Name (Legal Business Name): GARY J SCHMIDT MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11605 STUDT AVE SUITE ONE
SAINT LOUIS MO
63141-7052
US

IV. Provider business mailing address

PO BOX 1125
MARYLAND HEIGHTS MO
63043-1125
US

V. Phone/Fax

Practice location:
  • Phone: 314-699-9818
  • Fax:
Mailing address:
  • Phone: 314-432-2580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberMO107985
License Number StateMO

VIII. Authorized Official

Name: DR. GARY J SCHMIDT
Title or Position: OWNER
Credential: M.D.
Phone: 314-699-9818