Healthcare Provider Details

I. General information

NPI: 1720089022
Provider Name (Legal Business Name): HILDEGARD A.E. SCHONE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 SE STARK ST. SUITE 102
GRESHAM OR
97030
US

IV. Provider business mailing address

25500 SE STARK ST. SUITE 102
GRESHAM OR
97030
US

V. Phone/Fax

Practice location:
  • Phone: 503-661-7107
  • Fax: 503-661-3011
Mailing address:
  • Phone: 503-661-7107
  • Fax: 503-661-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8493
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD08493
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: