Provider Demographics
NPI:1902877103
Name:SCHREUDER, JOHN GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GERARD
Last Name:SCHREUDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 76TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2758
Mailing Address - Country:US
Mailing Address - Phone:206-275-2122
Mailing Address - Fax:206-275-0860
Practice Address - Street 1:2553 76TH AVE SE
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2758
Practice Address - Country:US
Practice Address - Phone:206-275-2122
Practice Address - Fax:206-275-0860
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA38033208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAH13501Medicare UPIN
WAH13501Medicare ID - Type Unspecified