Provider Demographics
NPI:1558320085
Name:SCHULZ, JOHN T III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:SCHULZ
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 FRUIT STREET
Mailing Address - Street 2:GRB 1300
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:617-726-3712
Mailing Address - Fax:617-726-4127
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:GRB 1300
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-3712
Practice Address - Fax:617-726-4127
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT043880208600000X, 2086S0127X
NY2674452086S0127X
MA154933208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001438804Medicaid
NY03688731Medicaid
CT001438804Medicaid
NY03688731Medicaid