Healthcare Provider Details

I. General information

NPI: 1932157013
Provider Name (Legal Business Name): SARA B. SCHRADER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 HIGHWAY 61 N
TUNICA MS
38676-9683
US

IV. Provider business mailing address

227 BELLEWETHER PASS
RIDGELAND MS
39157-8758
US

V. Phone/Fax

Practice location:
  • Phone: 662-357-0012
  • Fax: 662-357-0021
Mailing address:
  • Phone: 601-605-0459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number28505
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number10788
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10788
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: