Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | ME102872 | FL |
NPI | 1265530760 |
---|---|
Provider Name | George Schroeder |
First Address | Ormond Beach, FL 32174-5130 |
Second Address | Ormond Beach, FL 32174-5130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 15/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H74233 | (02) | IL |