Provider Demographics
NPI:1063462430
Name:SHULTZ, AMY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 BROOKWOOD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1315
Mailing Address - Country:US
Mailing Address - Phone:580-786-4590
Mailing Address - Fax:580-786-4593
Practice Address - Street 1:1509 BROOKWOOD AVE STE B
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1315
Practice Address - Country:US
Practice Address - Phone:580-786-4590
Practice Address - Fax:580-786-4593
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22384207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200069950AMedicaid
OKH95862Medicare UPIN
OK246622905Medicare PIN