Provider Demographics
NPI:1841458056
Name:SCHULTZ, SCOTT KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:KEITH
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 1:224 PEMBROKE DR
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-6200
Mailing Address - Country:US
Mailing Address - Phone:843-689-3937
Mailing Address - Fax:843-689-5550
Practice Address - Street 1:224 PEMBROKE DR
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-6200
Practice Address - Country:US
Practice Address - Phone:843-689-3937
Practice Address - Fax:843-689-5550
Is Sole Proprietor?:No
Enumeration Date:2008-05-26
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-112451207W00000X
SC36107207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8750Medicare PIN