Provider Demographics
NPI:1265532253
Name:SHULTZ, CLOYD WILLIAM JR (PA)
Entity type:Individual
Prefix:MR
First Name:CLOYD
Middle Name:WILLIAM
Last Name:SHULTZ
Suffix:JR
Gender:M
Credentials:PA
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Mailing Address - Street 1:720 CHERRY BLOSSOM CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-5706
Mailing Address - Country:US
Mailing Address - Phone:215-823-5880
Mailing Address - Fax:215-823-4309
Practice Address - Street 1:VA MEDICAL CENTER
Practice Address - Street 2:UNIVERSITY AND WOODLAND AVENUES
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-823-5880
Practice Address - Fax:215-823-4309
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PAMA000120L363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical