Provider Demographics
NPI:1538117775
Name:SCHULTZ, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:403 SUMMIT BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021
Mailing Address - Country:US
Mailing Address - Phone:303-429-6448
Mailing Address - Fax:303-951-3701
Practice Address - Street 1:403 SUMMIT BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021
Practice Address - Country:US
Practice Address - Phone:303-429-6448
Practice Address - Fax:303-951-3701
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO33826207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF30181Medicare UPIN
COC803964Medicare PIN
CO803964Medicare ID - Type Unspecified