Basic Information
| Provider Information | |||||||||
| NPI: | 1417046483 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHNEIDER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | DUANE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26028 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871256028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052627000 | ||||||||
| FaxNumber: | 5052627000 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 N 6TH ST | ||||||||
| Address2: | |||||||||
| City: | BELEN | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870023605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058644646 | ||||||||
| FaxNumber: | 5058611843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 05/10/2017 | ||||||||
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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 | 80-91 | NM | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110144154 | 01 | NM | RR MEDICARE | OTHER | 73773 | 01 | NM | CARE | OTHER | 742850726 | 01 | NM | CHAMPUS/TRICARE | OTHER | 2001008899 | 01 | NM | PRESBYTERIAN HEALTH PLANS | OTHER | 27201 | 05 | NM | MEDICAID | 659 | 01 | NM | LOVELACE HEALTH PLANS | OTHER | NM002745 | 01 | NM | BLUE CROSS BLUE SHIELD | OTHER |