Healthcare Provider Details

I. General information

NPI: 1295775302
Provider Name (Legal Business Name): JEAN C SCHULMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13640 N PLAZA DEL RIO BLVD STE 120
PEORIA AZ
85381-4846
US

IV. Provider business mailing address

13640 N PLAZA DEL RIO BLVD
PEORIA AZ
85381-4846
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-3880
  • Fax: 623-933-8371
Mailing address:
  • Phone: 623-876-3800
  • Fax: 623-933-8371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number16834
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number16834
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: