Provider Demographics
NPI:1902530835
Name:SCHMIDT, ROBERT HALE (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:HALE
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11335 SSG SIMS ST
Mailing Address - Street 2:
Mailing Address - City:FT BLISS
Mailing Address - State:TX
Mailing Address - Zip Code:79918
Mailing Address - Country:US
Mailing Address - Phone:157-422-2739
Mailing Address - Fax:
Practice Address - Street 1:11335 SSG SIMS ST
Practice Address - Street 2:
Practice Address - City:FT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79918
Practice Address - Country:US
Practice Address - Phone:915-742-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
TXPA15992363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171000000XOther Service ProvidersMilitary Health Care Provider