Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | MD9504# | PA |
NPI | 1982832184 |
---|---|
Provider Name | Dr. Paul Louis Schraeder |
First Address | Philadelphia, PA 19106-3727 |
Second Address | Philadelphia, PA 19106-3727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2009 |
Last Update Date | 25/06/2009 |