Provider Demographics
NPI:1730176900
Name:SCHULTZ, JOHN P (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:SCHULTZ
Suffix:
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:PO BOX 2613
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-1813
Mailing Address - Country:US
Mailing Address - Phone:304-723-3967
Mailing Address - Fax:304-723-4007
Practice Address - Street 1:PO BOX 2613
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-1813
Practice Address - Country:US
Practice Address - Phone:304-723-3967
Practice Address - Fax:304-723-4007
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17401207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0971140Medicaid
WV0053950001Medicaid
WV0053950001Medicaid
OH0971140Medicaid