Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | ML20009077 | WA |
N | 208600000X | Surgeon | ML20009077 | WA |
Y | 2086S0105X | Surgery of the Hand | 51020 | AZ |
NPI | 1760682660 |
---|---|
Provider Name | Brent Earl Schultz |
First Address | Phoenix, AZ 85004 |
Second Address | Phoenix, AZ 85004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2007 |
Last Update Date | 01/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
055418 | (05) | AZ |