Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | ME62431 | FL |
Y | 2080P0201X | Pediatric Allergist | ME62431 | FL |
NPI | 1942211479 |
---|---|
Provider Name | Dr. Jacob D. Schrum |
First Address | Rockland, DE 19732-0191 |
Second Address | Jacksonville, FL 32207-8426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 10/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000516887A | (05) | GA |
1528412 | (05) | LA |
371581700 | (05) | FL |
F36904 | (02) |