Provider Demographics
NPI:1093830333
Name:SCHALLER, JOHN LAWRENCE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LAWRENCE
Last Name:SCHALLER
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 E COTTON CENTER BLVD BLDG 1 # 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-8874
Mailing Address - Country:US
Mailing Address - Phone:602-659-1123
Mailing Address - Fax:
Practice Address - Street 1:4645 E COTTON CENTER BLVD BLDG 1 # 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-8874
Practice Address - Country:US
Practice Address - Phone:602-659-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17949207R00000X, 2083P0500X
CAG66859207R00000X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine