=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386732121
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGORY PATRICK SCHROEDL M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1550 N 115TH ST NORTHWEST HOSPITAL EMERGENCY DEPARTMENT
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98133-8401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-368-1700
-----------------------------------------------------
Fax | 206-368-1949
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5203 82ND AVE SE
-----------------------------------------------------
City | MERCER ISLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-232-8528
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | MD00017571
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------