Basic Information
Provider Information | |||||||||
NPI: | 1639312036 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHWARTZ | ||||||||
FirstName: | DOUGLAS | ||||||||
MiddleName: | WILLIAM | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3717 TURMAN LOOP | ||||||||
Address2: | 101 | ||||||||
City: | WESLEY CHAPEL | ||||||||
State: | FL | ||||||||
PostalCode: | 335447794 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8134020238 | ||||||||
FaxNumber: | 8139075559 | ||||||||
Practice Location | |||||||||
Address1: | 3717 TURMAN LOOP | ||||||||
Address2: | 101 | ||||||||
City: | WESLEY CHAPEL | ||||||||
State: | FL | ||||||||
PostalCode: | 335447794 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8134020238 | ||||||||
FaxNumber: | 8139075559 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/14/2009 | ||||||||
LastUpdateDate: | 08/31/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 208M00000X | OS12943 | FL | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 207R00000X | OS12943 | FL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 013545500 | 05 | FL |   | MEDICAID | P01548580 | 01 | FL | RR MCR | OTHER | 14Z5F | 01 | FL | BCBS | OTHER |