Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 461G | WI |
NPI | 1033120431 |
---|---|
Provider Name | Dr. John W Schoonenberg |
First Address | Milwaukee, WI 53201-1881 |
Second Address | Milwaukee, WI 53201-1881 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1223S0112X | PROVIDER TAXONOMY (01) | WI |
33360600 | (05) | WI |