Healthcare Provider Details

I. General information

NPI: 1992789143
Provider Name (Legal Business Name): ALLISON A SCHULTZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6709 ACADEMY RD NE STE A
ALBUQUERQUE NM
87109-3363
US

IV. Provider business mailing address

6709 ACADEMY RD NE STE A
ALBUQUERQUE NM
87109-3363
US

V. Phone/Fax

Practice location:
  • Phone: 505-308-3145
  • Fax:
Mailing address:
  • Phone: 505-308-3145
  • Fax: 505-308-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number47441-020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD88-262
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: