Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | M6210 | ID |
N | 208000000X | Pediatrician | MD00040525 | WA |
NPI | 1013090828 |
---|---|
Provider Name | Gregory P Schultz |
First Address | Lewiston, ID 83501-7301 |
Second Address | Lewiston, ID 83501-7301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 07/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0210278 | LABOR & INDUSTRIES (01) | WA |
1000325 | (05) | WA |
1013090828 | (05) | ID |
1013090828 | REGENCE BLUE CROSS (01) | ID |
1127194 | DMERC (01) | ID |
841377860 | MISCELLANEOUS INSURANCE (01) | ID |
DF391 | BLUE CROSS (01) | ID |
F53416 | (02) | ID |