Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 2523 | SD |
NPI | 1952366395 |
---|---|
Provider Name | Stephan D Schroeder |
First Address | Miller, SD 57362-1238 |
Second Address | Miller, SD 57362-1238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 12/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5600360 | (05) | SD |