Healthcare Provider Details

I. General information

NPI: 1780630202
Provider Name (Legal Business Name): JAMES M SCHROEDER P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3036 NE MLK JR BLVD
PORTLAND OR
97212-3053
US

IV. Provider business mailing address

798 EASTLAND DR
TWIN FALLS ID
83301-6856
US

V. Phone/Fax

Practice location:
  • Phone: 503-283-3763
  • Fax:
Mailing address:
  • Phone: 208-734-3312
  • Fax: 208-734-3313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-185
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA154561
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: