Provider Demographics
NPI:1902023609
Name:SCHULTZ, VICTOR E (PA)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:E
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6889 W BRILES RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-7015
Mailing Address - Country:US
Mailing Address - Phone:602-272-7676
Mailing Address - Fax:
Practice Address - Street 1:19401 N CAVE CREEK RD
Practice Address - Street 2:SUITE # 18
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-4037
Practice Address - Country:US
Practice Address - Phone:602-996-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1301363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant