Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 12005942 | IN |
NPI | 1104982065 |
---|---|
Provider Name | Dr. William Frederick Schultz JR. |
First Address | Columbus, IN 47203-4466 |
Second Address | Columbus, IN 47203-4466 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 10/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000199670 | BCBS (01) | IN |
T81849 | (02) | IN |