Basic Information
| Provider Information | |||||||||
| NPI: | 1427022755 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHOENFELD | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4020 SERANGO CT | ||||||||
| Address2: | |||||||||
| City: | WEST LINN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970682840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203439734 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 101 COLE AVE | ||||||||
| Address2: | |||||||||
| City: | BISBEE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856031327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204325383 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2006 | ||||||||
| LastUpdateDate: | 10/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | C51637 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 60717765 | WA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 37752 | AZ | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 161224 | OR | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 500HBE168CT01 | 01 | CT | BLUECROSS BLUESHIELD | OTHER |