Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | G31270 | CA |
NPI | 1124050430 |
---|---|
Provider Name | Paul J Schunke |
First Address | Modesto, CA 95355-4201 |
Second Address | Modesto, CA 95355-4201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 03/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G312700 | (05) | CA |
A44708 | (02) | CA |