Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G52429 | CA |
Y | 208600000X | Surgeon | G52429 | CA |
N | 2086S0127X | Trauma Surgeon | G52429 | CA |
N | 2086S0129X | Vascular Surgeon | G52429 | CA |
NPI | 1275614596 |
---|---|
Provider Name | Brian Frederick Schmidt |
First Address | Santa Rosa, CA 95403-3634 |
Second Address | Santa Rosa, CA 95404-3601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 10/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G524290 | BLUE SHIELD OF CALIFORNIA (01) | CA |
1275614596 | (05) | CA |
E91844 | (02) | CA |
P00469232 | RAILROAD MEDICARE (01) | CA |