Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 3405-06 | MS |
N | 1223G0001X | General Practice | 106 | AL |
N | 213EG0000X | General Practice | 106 | AL |
N | 1223G0001X | General Practice | 150563 | NC |
N | 213EG0000X | General Practice | 150563 | NC |
NPI | 1003916826 |
---|---|
Provider Name | Dr. Benjamin Leon Schrock |
First Address | Biloxi, MS 39532-2109 |
Second Address | Biloxi, MS 39532-2109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 28/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60115B | (02) | NC |