Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 34-00-6467-S | OH |
NPI | 1033111802 |
---|---|
Provider Name | Dr. Timothy Lee Schoonover |
First Address | Centerville, OH 45459-3811 |
Second Address | Centerville, OH 45459-3811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 25/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0263003 | (05) | OH |
1033111802 | CHAMPUS/TRICARE (01) | OH |
F88449 | (02) |