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General NPI Number Information
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NPI Number | 1457538654
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Entity Type | Organization
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Legal Business Name | CAPE COUNTY OTOLARYNGOLOGY HEAD & NECK SURGERY INC
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Dates
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Enumeration Date | 01/30/2008
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 3203 BLATTNER DR
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63703-6360
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Country | US
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Telephone | 573-334-5007
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Fax | 573-334-6369
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Provider Business Mailing Address
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Address Line | 3203 BLATTNER DR
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63703-6360
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Country | US
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Telephone | 573-334-5007
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Fax | 573-334-6369
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WALTER A SCHROEDER JR
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Credential | DO, MD
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Telephone | 573-334-5007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | R9980
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License Number State | MO
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