Provider Demographics
NPI:1619013976
Name:SCHULTZ, DEAN ALLEN JR (MD)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:ALLEN
Last Name:SCHULTZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-3509
Mailing Address - Country:US
Mailing Address - Phone:325-480-9280
Mailing Address - Fax:325-400-2007
Practice Address - Street 1:1309 HICKORY ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-3509
Practice Address - Country:US
Practice Address - Phone:325-480-9280
Practice Address - Fax:325-400-2007
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2313207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116415404Medicaid
TXF68139Medicare UPIN