Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 9712365-1205 | UT |
Y | 207YP0228X | Pediatric Otolaryngology | 9712365-1205 | UT |
NPI | 1588976328 |
---|---|
Provider Name | Jordan Carlton Schramm |
First Address | Provo, UT 84604-3306 |
Second Address | Provo, UT 84604-3306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2010 |
Last Update Date | 20/10/2017 |