Provider Demographics
NPI:1649451865
Name:GARY C KOHRING & RAYMOND SCHNEIDER PTR
Entity type:Organization
Organization Name:GARY C KOHRING & RAYMOND SCHNEIDER PTR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:480-831-0150
Mailing Address - Street 1:2034 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-4004
Mailing Address - Country:US
Mailing Address - Phone:480-831-0150
Mailing Address - Fax:480-839-3492
Practice Address - Street 1:2034 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-4004
Practice Address - Country:US
Practice Address - Phone:480-831-0150
Practice Address - Fax:480-839-3492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z6731OtherHEALTHNET ID
5612078OtherAETNA PIN
AZCQ2504OtherRR MEDICARE
AZ1Z6731OtherHEALTHNET ID
5612078OtherAETNA PIN