Provider Demographics
NPI: | 1629015763 |
---|---|
Name: | SCHNITZ, WILLIAM MARTIN (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | WILLIAM |
Middle Name: | MARTIN |
Last Name: | SCHNITZ |
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: | 3555 NW 58TH ST STE 804 |
Mailing Address - Street 2: | |
Mailing Address - City: | OKLAHOMA CITY |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 73112-4703 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 405-548-0430 |
Mailing Address - Fax: | 405-463-4408 |
Practice Address - Street 1: | 3555 NW 58TH ST STE 804 |
Practice Address - Street 2: | |
Practice Address - City: | OKLAHOMA CITY |
Practice Address - State: | OK |
Practice Address - Zip Code: | 73112-4703 |
Practice Address - Country: | US |
Practice Address - Phone: | 405-548-0430 |
Practice Address - Fax: | 405-463-4408 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-05-31 |
Last Update Date: | 2018-04-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OK | 16521 | 207R00000X, 207RR0500X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OK | 100095820B | Medicaid | |
OK | 100095820B | Medicaid | |
E11744 | Medicare UPIN |