Provider Demographics
NPI:1285637579
Name:SCHULTE, BRETT J (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:J
Last Name:SCHULTE
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 1:121 SOTOYOME ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:121 SOTOYOME ST STE 201
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405
Practice Address - Country:US
Practice Address - Phone:707-579-2100
Practice Address - Fax:707-523-0616
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20404208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORO2WCJLBDMedicare ID - Type Unspecified
ORG46420Medicare UPIN
OR150047Medicare ID - Type Unspecified