Healthcare Provider Details

I. General information

NPI: 1255544268
Provider Name (Legal Business Name): MITCHAL ARIC SCHREINER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7788 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4342
US

IV. Provider business mailing address

7788 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4342
US

V. Phone/Fax

Practice location:
  • Phone: 505-999-1600
  • Fax: 505-999-1654
Mailing address:
  • Phone: 505-999-1600
  • Fax: 505-999-1654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMD26494
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD2009-0489
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD60086278
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: