Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 135000987 | IL |
Y | 213ES0103X | Foot & Ankle Surgery | E5654 | CA |
NPI | 1053830463 |
---|---|
Provider Name | Tyson Marquis Schmidthuber |
First Address | Encinitas, CA 92024-1335 |
Second Address | Encinitas, CA 92024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2017 |
Last Update Date | 18/03/2021 |