Provider Demographics
NPI:1124014824
Name:SCHULTZ, RAYMOND OCONNELL (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:OCONNELL
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 1:6044 MAIN ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5411
Mailing Address - Country:US
Mailing Address - Phone:716-631-8500
Mailing Address - Fax:716-631-5101
Practice Address - Street 1:6044 MAIN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5411
Practice Address - Country:US
Practice Address - Phone:716-650-4622
Practice Address - Fax:716-276-3400
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18343012082S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
240005927OtherMEDICARE RAILROAD
G67453Medicare UPIN