Healthcare Provider Details

I. General information

NPI: 1275758583
Provider Name (Legal Business Name): GABE VICTOR SCHULDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NOBLE ST
FAIRBANKS AK
99701-4922
US

IV. Provider business mailing address

1001 NOBLE ST
FAIRBANKS AK
99701-4922
US

V. Phone/Fax

Practice location:
  • Phone: 907-459-3500
  • Fax: 907-459-3588
Mailing address:
  • Phone: 907-459-3500
  • Fax: 907-459-3588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number4301088267
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6624
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: