Provider Demographics
NPI:1538177241
Name:SHULTZ, GARY L (DO)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:SHULTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1086
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52004-1086
Mailing Address - Country:US
Mailing Address - Phone:563-556-3944
Mailing Address - Fax:
Practice Address - Street 1:202 10TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403
Practice Address - Country:US
Practice Address - Phone:563-556-3944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0745942085R0001X
IL036-1046752085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1538177241 1Medicaid
GA003166645AMedicaid
GA102I923927Medicare PIN
IL0407950001Medicare NSC
ILL87819Medicare PIN
ILA02720Medicare UPIN