Provider Demographics
NPI:1871520544
Name:SCHMIDT, CRAIG J (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:J
Last Name:SCHMIDT
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 1:901 PATIENTS FIRST DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4700
Mailing Address - Country:US
Mailing Address - Phone:636-239-7500
Mailing Address - Fax:636-239-2836
Practice Address - Street 1:307 NOONAN DR
Practice Address - Street 2:
Practice Address - City:PACIFIC
Practice Address - State:MO
Practice Address - Zip Code:63069-1118
Practice Address - Country:US
Practice Address - Phone:636-271-9100
Practice Address - Fax:636-257-6016
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204646608Medicaid
080142757OtherRAILROAD MEDICARE
015012943Medicare ID - Type Unspecified
F82789Medicare UPIN
MO204646608Medicaid