Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 9494 | FL |
NPI | 1548431851 |
---|---|
Provider Name | Prof. John P. Schaeffer III |
First Address | Port Orange, FL 32129-9623 |
Second Address | Port Orange, FL 32129-9623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2008 |
Last Update Date | 13/03/2008 |