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General NPI Number Information
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NPI Number | 1740483031
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Entity Type | Individual
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Provider Name | ROGER G SCHMIDT PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 88TH MEDICAL GROUP/MDOS 4881 SUGAR MAPLE DR.
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City | DAYTON
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State | OH
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Zip | 45433-5529
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Country | US
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Telephone | 937-713-1244
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Fax |
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Provider Business Mailing Address
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Address Line | 88TH MEDICAL GROUP/MDOS 4881 SUGAR MAPLE DRIVE
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City | APO
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State | AP
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Zip | 45433
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Country | US
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Telephone | 937-713-1244
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6785
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | P6785
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License Number State | OH
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