Basic Information
| Provider Information | |||||||||
| NPI: | 1063499416 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHNEIDER | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3501 S SONCY RD | ||||||||
| Address2: | STE 140 | ||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791196407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063555625 | ||||||||
| FaxNumber: | 8063522245 | ||||||||
| Practice Location | |||||||||
| Address1: | 3501 S SONCY RD | ||||||||
| Address2: | STE 140 | ||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791196407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063555625 | ||||||||
| FaxNumber: | 8063522245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 04/23/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | E0289 | TX | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 040017693 | 01 | TX | RR MEDICARE | OTHER | 123443103 | 01 | TX | FIRSTCARE/SWHEALTHLIFE | OTHER | 8H0732 | 01 | TX | BCBS | OTHER | 110275804 | 05 | TX | MEDICAID |