Healthcare Provider Details

I. General information

NPI: 1730176900
Provider Name (Legal Business Name): JOHN P SCHULTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 2613
WEIRTON WV
26062-1813
US

IV. Provider business mailing address

PO BOX 2613
WEIRTON WV
26062-1813
US

V. Phone/Fax

Practice location:
  • Phone: 304-723-3967
  • Fax: 304-723-4007
Mailing address:
  • Phone: 304-723-3967
  • Fax: 304-723-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17401
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number17401
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: