Healthcare Provider Details

I. General information

NPI: 1801983374
Provider Name (Legal Business Name): PHILIP SCOTT SCHAUWEKER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 ELM AVE SUITE 407
LONG BEACH CA
90813-3271
US

IV. Provider business mailing address

1043 ELM AVE SUITE 407
LONG BEACH CA
90813-3271
US

V. Phone/Fax

Practice location:
  • Phone: 562-491-0505
  • Fax: 562-491-0525
Mailing address:
  • Phone: 562-491-0505
  • Fax: 562-491-0525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberE3911
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberE3911
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE3911
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE3911
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE3911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: