Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 04-32151 | KS |
N | 207QS0010X | Family Doctor - Sports Medicine | 2012028256 | MO |
NPI | 1174608111 |
---|---|
Provider Name | Dr. Jonathan David Schultz |
First Address | Overland Park, KS 66215-2305 |
Second Address | Kansas City, MO 64139-1236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 04/01/2022 |