Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 174 | OR |
NPI | 1689698797 |
---|---|
Provider Name | Mr. Robert Dewayne Schroeder |
First Address | Grants Pass, OR 97526-1420 |
Second Address | Grants Pass, OR 97526-1420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
127824 | OMAP (01) | OR |