Provider Demographics
NPI:1891709291
Name:SCHULTZ, RICHARD DWAYNE (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DWAYNE
Last Name:SCHULTZ
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 1:2001 NE 48 COURT
Mailing Address - Street 2:STE 2
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:954-772-0890
Mailing Address - Fax:954-772-0891
Practice Address - Street 1:2001 NE 48 COURT
Practice Address - Street 2:STE 2
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-772-0890
Practice Address - Fax:954-772-0891
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME9922208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D61398Medicare UPIN
FL06620Medicare ID - Type Unspecified