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General NPI Number Information
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NPI Number | 1558620286
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Entity Type | Organization
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Legal Business Name | SCHNEIDER FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 02/04/2014
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Provider Practice Location Address
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Address Line | 5060 N 40TH ST STE 108
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City | PHOENIX
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State | AZ
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Zip | 85018-2145
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Country | US
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Telephone | 602-845-1670
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Fax | 602-445-6871
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Provider Business Mailing Address
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Address Line | 5150 N 16TH ST STE B232
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City | PHOENIX
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State | AZ
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Zip | 85016-3990
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Country | US
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Telephone | 602-845-1670
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Fax | 602-445-6871
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | MARVIN C SCHNEIDER
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Credential | M.D.
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Telephone | 602-845-1670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4036
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License Number State | AZ
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