Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS4697 | FL |
NPI | 1003816844 |
---|---|
Provider Name | Mr. Robert A Schamberger SR. |
First Address | Oviedo, FL 32765-9025 |
Second Address | Oviedo, FL 32765-9025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2005 |
Last Update Date | 31/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
049136500 | (05) | FL |
E21482 | (02) |