Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 14002 | NV |
N | 207Q00000X | Family Doctor | 4301047795 | MI |
N | 207QS0010X | Family Doctor - Sports Medicine | 4301047795 | MI |
NPI | 1063501922 |
---|---|
Provider Name | Thomas L. Schwenk |
First Address | Reno, NV 89503 |
Second Address | Reno, NV 89557 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 04/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1641600 | (05) | MI |
B48511 | (02) | |
B48511 | (02) | MA |