Provider Demographics
NPI:1558379420
Name:SHULTZ, JEFFREY SAVILLE (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SAVILLE
Last Name:SHULTZ
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 1:2000 EOFF ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-234-8363
Mailing Address - Fax:304-234-8133
Practice Address - Street 1:2000 EOFF ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-234-8363
Practice Address - Fax:304-234-8133
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV9054207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110198916OtherRAILROAD MEDICARE
WV0082069000Medicaid
OH0318114Medicaid
WVSH7268341Medicare ID - Type Unspecified
WV0082069000Medicaid