Provider Demographics
NPI:1871683482
Name:JOHN SCHOR MD PLC
Entity Type:Organization
Organization Name:JOHN SCHOR MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-639-0909
Mailing Address - Street 1:PO BOX 4445
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-2621
Mailing Address - Country:US
Mailing Address - Phone:928-639-0909
Mailing Address - Fax:928-639-4632
Practice Address - Street 1:450 S WILLARD ST
Practice Address - Street 2:STE 107
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-6743
Practice Address - Country:US
Practice Address - Phone:928-639-0909
Practice Address - Fax:928-639-4632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34465208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ131591Medicaid
AZG03513Medicare UPIN
AZ131591Medicaid