Provider Demographics
NPI:1760759104
Name:SCHROTH, BRANDON WILLIAM (MPA)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:WILLIAM
Last Name:SCHROTH
Suffix:
Gender:M
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 357051 NASNI
Mailing Address - Street 2:COMMANDER NAVAL AIR FORCES
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92135-7051
Mailing Address - Country:US
Mailing Address - Phone:619-545-1148
Mailing Address - Fax:619-767-7417
Practice Address - Street 1:357051 NASNI
Practice Address - Street 2:COMMANDER NAVAL AIR FORCES
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92135-7051
Practice Address - Country:US
Practice Address - Phone:619-545-1148
Practice Address - Fax:619-767-7417
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1102201363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical