Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | R2B98 | MO |
NPI | 1457466104 |
---|---|
Provider Name | Dr. Susan Bromberg Schneider |
First Address | Chesterfield, MO 63017-3625 |
Second Address | Chesterfield, MO 63017-3625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 06/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201723509 | (05) | MO |
841682728 | TAX ID (01) | |
A25759 | (02) | |
P00300554 | RR MEDICARE (01) |