Healthcare Provider Details

I. General information

NPI: 1902877103
Provider Name (Legal Business Name): JOHN GERARD SCHREUDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2553 76TH AVE SE
MERCER ISLAND WA
98040-2758
US

IV. Provider business mailing address

2553 76TH AVE SE
MERCER ISLAND WA
98040-2758
US

V. Phone/Fax

Practice location:
  • Phone: 206-275-2122
  • Fax: 206-275-0860
Mailing address:
  • Phone: 206-275-2122
  • Fax: 206-275-0860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38033
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: