Healthcare Provider Details

I. General information

NPI: 1124022041
Provider Name (Legal Business Name): DOUGLAS ALLEN SCHULTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2890 NIAGARA FALLS BLVD
NORTH TONAWANDA NY
14120-1114
US

IV. Provider business mailing address

2890 NIAGARA FALLS BLVD
NORTH TONAWANDA NY
14120-1114
US

V. Phone/Fax

Practice location:
  • Phone: 716-807-7337
  • Fax: 716-807-0848
Mailing address:
  • Phone: 716-807-7337
  • Fax: 716-807-0848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number210277
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: