Healthcare Provider Details

I. General information

NPI: 1316446339
Provider Name (Legal Business Name): BROOKINGS INTERNAL MEDICINE-PATHOLOGY-DISEASES OF THE SKIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97839 SHOPPING CENTER AVE # 7229
HARBOR OR
97415-9403
US

IV. Provider business mailing address

97839 SHOPPING CENTER AVE # 7229
HARBOR OR
97415-9403
US

V. Phone/Fax

Practice location:
  • Phone: 541-254-9424
  • Fax: 541-254-9425
Mailing address:
  • Phone: 541-254-9424
  • Fax: 541-254-9425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD126149
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD126149
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD126149
License Number StateOR

VIII. Authorized Official

Name: RICHARD FRANK SCHULTZ
Title or Position: OWNER
Credential: MD
Phone: 541-254-9424