Provider Demographics
NPI:1861592826
Name:SHULTZ, GAIL N (MD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:N
Last Name:SHULTZ
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 1:6838 N CORTE CALABAZA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4141
Mailing Address - Country:US
Mailing Address - Phone:520-743-0411
Mailing Address - Fax:
Practice Address - Street 1:4110 W SWEETWATER DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-9348
Practice Address - Country:US
Practice Address - Phone:520-743-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6192207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ221862Medicaid