Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | P4817 | TX |
N | 2088P0231X | Pediatric Urologist | P4817 | TX |
NPI | 1013111806 |
---|---|
Provider Name | Bruce Jeremy Schlomer |
First Address | Dallas, TX 75207-2700 |
Second Address | Dallas, TX 75207-2700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 29/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
313524603 | (05) | TX |