MEDICARE: DR. JORDAN MARY SCHROEDER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208100000X	Physical Medicine & Rehabilitation Physician	MDRE.ML.61417441	WA

General Provider Information

NPI Number	:	1003557141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN MARY SCHROEDER MD

Provider Business Mailing Address
First Line	:	1959 NE PACIFIC STREET BB-928 BOX 356490
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-0001
Country	:	US
Telephone Number	:	425-283-6345
Fax Number	:

Provider Business Practice Location Address
First Line	:	DEPT REHAB MEDICINE 1959 NE PACIFIC ST # 356490 BB-928
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-2307
Country	:	US
Telephone Number	:	206-685-0936
Fax Number	:	206-616-3908

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	02/13/2024

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