Provider Demographics
NPI:1205815743
Name:SCHULZE, RICHARD RANDOLPH JR (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:RANDOLPH
Last Name:SCHULZE
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 1:728 E 67TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4608
Mailing Address - Country:US
Mailing Address - Phone:912-352-3120
Mailing Address - Fax:912-352-1405
Practice Address - Street 1:728 E 67TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4608
Practice Address - Country:US
Practice Address - Phone:912-352-3120
Practice Address - Fax:912-352-1405
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038949207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00652935AMedicaid
GA00652935AMedicaid
18BDCZZMedicare ID - Type Unspecified