Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | R9269 | MO |
NPI | 1104860360 |
---|---|
Provider Name | Howard R Schwartz |
First Address | Springfield, MO 65808-9007 |
Second Address | Springfield, MO 65807-7310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 12/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107069 | BLUE CROSS/BLUE SHIELD (01) | |
200857100 | (05) | MO |
E21351 | (02) |