Healthcare Provider Details

I. General information

NPI: 1003965294
Provider Name (Legal Business Name): JEROME JOHN SCHULTE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PHILADELPHIA DR SUITE 4505
DAYTON OH
45406-1840
US

IV. Provider business mailing address

2222 PHILADELPHIA DR SUITE 4505
DAYTON OH
45406-1813
US

V. Phone/Fax

Practice location:
  • Phone: 937-734-2446
  • Fax: 937-734-4219
Mailing address:
  • Phone: 937-734-4363
  • Fax: 937-734-4181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number35-05-9121
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35-05-9121
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number35-05-9121
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: