Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 5391C | AL |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 5391C | AL |
N | 1223X0008X | Oral and Maxillofacial Radiology | 5391C | AL |
NPI | 1467550400 |
---|---|
Provider Name | Craig D Schmidtke |
First Address | Dothan, AL 36303-1985 |
Second Address | Dothan, AL 36303-1985 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51529237 | BCBS OF AL PROVIDER #I (01) | AL |
5391C | ALABAMA LICENSE # (01) | AL |
755031 | UNITED CONCORDIA PROVI # (01) | AL |
U75915 | (02) | AL |