MEDICARE: DR. JAY IRA SCHORR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME0041989	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487659603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY IRA SCHORR M.D.

Provider Business Mailing Address
First Line	:	2401 FRIST BLVD
Second Line	:	STE 1
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4800
Country	:	US
Telephone Number	:	772-464-0033
Fax Number	:	772-467-1150

Provider Business Practice Location Address
First Line	:	2401 FRIST BLVD
Second Line	:	STE 1
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4800
Country	:	US
Telephone Number	:	772-464-0033
Fax Number	:	772-467-1150

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	06/27/2008

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