Healthcare Provider Details

I. General information

NPI: 1104118470
Provider Name (Legal Business Name): PAUL CARL SCHUNK JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-5095
US

IV. Provider business mailing address

108 GREENSIDE LN
GEORGETOWN TX
78633-4396
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-3885
  • Fax:
Mailing address:
  • Phone: 202-491-4394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberQ1490
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: