Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | DPM0000000479 | TN |
NPI | 1033109327 |
---|---|
Provider Name | Paul Benjamin Schodowski |
First Address | Kingsport, TN 37660-4673 |
Second Address | Kingsport, TN 37660-4673 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 18/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U01973 | (02) | TN |