MEDICARE: WILLIAM JAMES SCHUMAN RD, LD

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	133V00000X	Registered Dietitian	ND2019	FL
2	133V00000X	Registered Dietitian	LD002190	GA

General Provider Information

NPI Number	:	1548418031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM JAMES SCHUMAN RD, LD

Provider Business Mailing Address
First Line	:	12551 DAYLIGHT TRL
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-8037
Country	:	US
Telephone Number	:	904-382-7831
Fax Number	:	866-926-3980

Provider Business Practice Location Address
First Line	:	960 NEW BERLIN RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-2073
Country	:	US
Telephone Number	:	904-757-8522
Fax Number	:	904-757-8529

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

Provider Enumeration Date	:	09/09/2008
Last Update Date	:	09/09/2008

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