Provider Demographics
NPI:1356346183
Name:SCHUTZ, RONALD WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WALTER
Last Name:SCHUTZ
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 1:19000 NW SQUIRRELTAIL LOOP
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-6784
Mailing Address - Country:US
Mailing Address - Phone:503-805-0077
Mailing Address - Fax:
Practice Address - Street 1:19000 NW SQUIRRELTAIL LOOP
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-6784
Practice Address - Country:US
Practice Address - Phone:503-805-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR174400000X
ORMD11311207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000BHPPRMedicare PIN
ORC93727Medicare UPIN