Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A10017 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | 5101016693 | MI |
NPI | 1245272004 |
---|---|
Provider Name | Dr. Andrew Ira Schwartz |
First Address | Lakeport, CA 95453-6360 |
Second Address | Lakeport, CA 95453-6360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 21/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20A 10017 | MEDICAL LICENSE (01) | CA |
5101016693 | MEDICAL LICENSE (01) | MI |
5315025405 | CONTROLLED SUBSTANCE # (01) | MI |
BS9684184 | DEA (01) | MI |
FHC71031F | (05) | CA |
OS 10051 | MEDICAL LICENSE (01) | FL |
W1508E | PTAN, BV362YZ AND BV362Y, (01) | CA |