Provider Demographics
NPI:1144296955
Name:SCHMITZ, MARK ALAN (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:SCHMITZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 MCARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-2325
Mailing Address - Country:US
Mailing Address - Phone:931-728-0155
Mailing Address - Fax:931-728-0109
Practice Address - Street 1:905 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2325
Practice Address - Country:US
Practice Address - Phone:931-728-0155
Practice Address - Fax:931-728-0109
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3301807Medicaid
TN3301807Medicaid
TN33018071Medicare PIN