Provider Demographics
NPI:1366461097
Name:SCHULTZ, JESS MORGAN (MD)
Entity Type:Individual
Prefix:
First Name:JESS
Middle Name:MORGAN
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:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:1200 E COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-3354
Practice Address - Country:US
Practice Address - Phone:509-384-3701
Practice Address - Fax:509-684-5817
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046312208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8943481OtherCRIME VICTIMS
WA0217205OtherLABOR & INDUSTRIES
OR149992Medicaid
WA8205411Medicaid
WA8457780Medicaid
OR026444Medicaid
WA8943530OtherCRIME VICTIMS
WA0217054OtherL & I
WA8943481OtherCRIME VICTIMS
OR026444Medicaid
OR149992Medicaid