Healthcare Provider Details

I. General information

NPI: 1821086208
Provider Name (Legal Business Name): PAUL D SCHNEIDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10510 GRAVELLY LAKE DR SW
LAKEWOOD WA
98499-5036
US

IV. Provider business mailing address

10510 GRAVELLY LAKE DR SW
TACOMA WA
98499-5036
US

V. Phone/Fax

Practice location:
  • Phone: 253-589-7030
  • Fax: 253-589-7033
Mailing address:
  • Phone: 253-597-7030
  • Fax: 253-597-7033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD000015726
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD000015726
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: