Basic Information
| Provider Information | |||||||||
| NPI: | 1235157868 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHROEDER | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | STUART | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34120 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895334120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757475050 | ||||||||
| FaxNumber: | 7757475005 | ||||||||
| Practice Location | |||||||||
| Address1: | 18653 WEDGE PARKWAY | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895113007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758537997 | ||||||||
| FaxNumber: | 7758537984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 12/01/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 7451 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | G83146 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 002016288 | 05 | NV | MEDICAID |