Healthcare Provider Details

I. General information

NPI: 1609855238
Provider Name (Legal Business Name): TODD CHRISTOPHER SCHMIDT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S KIRKWOOD RD SUITE 120
SAINT LOUIS MO
63122-7254
US

IV. Provider business mailing address

13 OAK VALLEY DR
WASHINGTON MO
63090-5659
US

V. Phone/Fax

Practice location:
  • Phone: 314-966-8887
  • Fax: 314-966-3869
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2003023668
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: