Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 17584 | MS |
NPI | 1033291778 |
---|---|
Provider Name | Robert Eugene Schmieg JR. |
First Address | Jackson, MS 39207-3287 |
Second Address | Jackson, MS 39216-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 16/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0120798 | (05) | MS |
1119784 | (05) | LA |
G59326 | (02) | |
P00637716 | RAILROAD MEDICARE (01) | MS |