Provider Demographics
NPI:1356450191
Name:SCHULTZ, BRIAN JAMES (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JAMES
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 1:1001 W WORLEY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2037
Mailing Address - Country:US
Mailing Address - Phone:573-214-2314
Mailing Address - Fax:573-814-2835
Practice Address - Street 1:1001 W WORLEY ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2037
Practice Address - Country:US
Practice Address - Phone:573-214-2314
Practice Address - Fax:573-814-2835
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004022187207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207308909Medicaid
MO104180003Medicare PIN
MO310085236Medicare PIN
MO207308909Medicaid