Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 0101238887 | VA |
Y | 207R00000X | Internist | 0101238887 | VA |
Y | 111NI0900X | Internist | 0101238887 | VA |
NPI | 1003875808 |
---|---|
Provider Name | John M Schruefer |
First Address | Downers Grove, IL 60515-1069 |
Second Address | Rockville, MD 20850-3334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 09/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010201942 | (05) | VA |
1003875808 | NPI (01) | VA |
540490687003 | TRICARE (01) | VA |
G15333 | (02) | VA |
G15333 | (02) | VI |