Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 12636 | RI |
NPI | 1790808020 |
---|---|
Provider Name | Jonathan Richard Schiller |
First Address | Providence, RI 02905-3236 |
Second Address | Providence, RI 02905-3236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 23/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12636 | RI FULL MEDICAL LICENSE (01) | RI |
LP 00166 | RI LICENSE (01) | RI |