Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | JS005206 | MI |
Y | 207Q00000X | Family Doctor | 5101005206 | MI |
NPI | 1902951809 |
---|---|
Provider Name | Dr. Jon L Schriner |
First Address | Grand Blanc, MI 48439-2460 |
Second Address | Grand Blanc, MI 48439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 20/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E26175 | (02) | MI |