Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 14449 | MA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 841 | VT |
NPI | 1508887225 |
---|---|
Provider Name | Dr. Roy A Schonbrun |
First Address | Greenfield, MA 01301 |
Second Address | Greenfield, MA 01301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14449 | LIC (01) | MA |
841 | LIC (01) | VT |
T56472 | (02) |