Healthcare Provider Details

I. General information

NPI: 1508963992
Provider Name (Legal Business Name): AMY SCHMIDT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 IRVING BLVD NW
ALBUQUERQUE NM
87114-5915
US

IV. Provider business mailing address

4420 IRVING BLVD NW
ALBUQUERQUE NM
87114-5915
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-6300
  • Fax: 505-727-9588
Mailing address:
  • Phone: 505-727-6300
  • Fax: 505-727-9588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number88260
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number88-260
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: