Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 08029 | IA |
NPI | 1063480747 |
---|---|
Provider Name | Jason Schmit |
First Address | Cedar Rapids, IA 52402-4844 |
Second Address | Cedar Rapids, IA 52402-4844 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0210112 | (05) | IA |
08823 | DELTA PROV # (01) | IA |
170454 | TRICARE PROV # (01) | IA |
38294 | WELLMARK PROVIDER # (01) | IA |