Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 01-03688 | KS |
N | 207R00000X | Internist | 01-03688 | KS |
N | 111NI0900X | Internist | 01-03688 | KS |
NPI | 1508896655 |
---|---|
Provider Name | Dr. Alvin Ray Schwerdtfager |
First Address | Lindsborg, KS 67456-2227 |
Second Address | Lindsborg, KS 67456-2227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 08/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007203 | BCBS PN FOR LINDSBORG (01) | KS |
01-03688 | STATE CERTIFICATE NUMBER (01) | KS |
023728 | BCBS PN FOR SALINA OFFICE (01) | KS |
T43909 | (02) | KS |