Provider Demographics
NPI:1003965294
Name:SCHULTE, JEROME JOHN JR (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:JOHN
Last Name:SCHULTE
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 1:2222 PHILADELPHIA DR
Mailing Address - Street 2:SUITE 4505
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-1813
Mailing Address - Country:US
Mailing Address - Phone:937-734-4363
Mailing Address - Fax:937-734-4181
Practice Address - Street 1:2200 PHILADELPHIA DR
Practice Address - Street 2:SUITE 4505
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1840
Practice Address - Country:US
Practice Address - Phone:937-734-2446
Practice Address - Fax:937-734-4219
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-91212084F0202X, 2084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2050179Medicaid
OH2050179Medicaid
OHH52947Medicare UPIN
OHSC7295141Medicare ID - Type Unspecified