Provider Demographics
NPI:1538112966
Name:SCHULZE, ERIC SUREN (MD PHD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:SUREN
Last Name:SCHULZE
Suffix:
Gender:M
Credentials:MD PHD
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 1888
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403
Mailing Address - Country:US
Mailing Address - Phone:800-945-2455
Mailing Address - Fax:903-453-2541
Practice Address - Street 1:7710T CHERRY PARK DR # 522
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2725
Practice Address - Country:US
Practice Address - Phone:877-572-8456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL14552085R0202X
ARE42902085R0202X
LAMD.12548R2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142957304Medicaid
TX142957307Medicaid
OK200101050AMedicaid
AR161955001Medicaid
NM78680352Medicaid
LA1535869Medicaid
AR5N652G180Medicare PIN
G15046Medicare UPIN
TX142957304Medicaid
TX142957307Medicaid
LA1535869Medicaid
WAG8878287Medicare PIN
TX300137056Medicare PIN