=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013914720
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KERRY M SCHWARTZ MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2005
-----------------------------------------------------
Last Update Date | 03/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 WILFORD HALL LOOP
-----------------------------------------------------
City | JBSA LACKLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78236-5638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-848-4022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1126 READING DR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32804-6730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-848-4022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | ME0036337
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------