Provider Demographics
NPI:1942293543
Name:SCHULTZ, GERALD R (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:R
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 1:58471 29 PALMS HWY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-5818
Mailing Address - Country:US
Mailing Address - Phone:760-228-1766
Mailing Address - Fax:760-228-9830
Practice Address - Street 1:58471 29 PALMS HWY
Practice Address - Street 2:SUITE 302
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-5818
Practice Address - Country:US
Practice Address - Phone:760-228-1766
Practice Address - Fax:760-228-9830
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2008-10-14
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
CAG14295207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G142951Medicaid
CA1531900001Medicare NSC
A39222Medicare UPIN