Basic Information
| Provider Information | |||||||||
| NPI: | 1417037250 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHMIDT | ||||||||
| FirstName: | NORMAN | ||||||||
| MiddleName: | DAGOBERT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 241011 | ||||||||
| Address2: | |||||||||
| City: | LODI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952419511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093348540 | ||||||||
| FaxNumber: | 2093682885 | ||||||||
| Practice Location | |||||||||
| Address1: | 1901 W KETTLEMAN LN | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LODI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952424337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093348540 | ||||||||
| FaxNumber: | 2093682885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 08/02/2016 | ||||||||
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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 | 207Q00000X | G64325 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00G643250 | 05 | CA | MEDICAID |