1780649020 NPI number — MR. WILLIAM ANTHONY SCHULTZ PA-C

Table of content: MR. WILLIAM ANTHONY SCHULTZ PA-C (NPI 1780649020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780649020 NPI number — MR. WILLIAM ANTHONY SCHULTZ PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHULTZ
Provider First Name:
WILLIAM
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780649020
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 WILFORD HALL LOOP BLDG 4554
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JBSA LACKLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78236-9908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-350-2440
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
673 MDG
Provider Second Line Business Practice Location Address:
5955 ZEAMER AVENUE
Provider Business Practice Location Address City Name:
JBER
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-350-2440
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 1062015 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 59-3310324 . This is a "TAXID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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