Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 36002509 | OH |
Y | 222Z00000X | Podiatrist | 36002509 | OH |
NPI | 1073505533 |
---|---|
Provider Name | Dr. Kevin Raymond Schroeder |
First Address | Parkersburg, WV 26104-1263 |
Second Address | Parkersburg, WV 26104-1263 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 02/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0752690 | (05) | OH |
1073505533 | (05) | WV |