Healthcare Provider Details

I. General information

NPI: 1942293543
Provider Name (Legal Business Name): GERALD R SCHULTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date: 03/27/2006
Reactivation Date: 04/03/2006

III. Provider practice location address

58471 29 PALMS HWY SUITE 302
YUCCA VALLEY CA
92284-5818
US

IV. Provider business mailing address

58471 29 PALMS HWY SUITE 302
YUCCA VALLEY CA
92284-5818
US

V. Phone/Fax

Practice location:
  • Phone: 760-228-1766
  • Fax: 760-228-9830
Mailing address:
  • Phone: 760-228-1766
  • Fax: 760-228-9830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG14295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: