Provider Demographics
NPI:1518924091
Name:SCHULZ, PETER R (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:R
Last Name:SCHULZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:P 212
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-346-8771
Mailing Address - Fax:760-773-1643
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:P 212
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-346-8771
Practice Address - Fax:760-773-1643
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA453320208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA453320Medicaid
D16389Medicare UPIN
CAA453320Medicare ID - Type Unspecified