Healthcare Provider Details

I. General information

NPI: 1881220812
Provider Name (Legal Business Name): SAMUEL TOBIN SCHNEIDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 BROADWAY HEATH BUILDING, 10TH FLOOR
SEATTLE WA
98122
US

IV. Provider business mailing address

747 BROADWAY HEATH BUILDING, 10TH FLOOR
SEATTLE WA
98122
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-2123
  • Fax:
Mailing address:
  • Phone: 206-386-2123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberML61070513
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: