Basic Information
| Provider Information | |||||||||
| NPI: | 1619013976 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHULTZ | ||||||||
| FirstName: | DEAN | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1309 HICKORY ST | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796013509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3254809280 | ||||||||
| FaxNumber: | 3254002007 | ||||||||
| Practice Location | |||||||||
| Address1: | 1309 HICKORY ST | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796013509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3254809280 | ||||||||
| FaxNumber: | 3254002007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | J2313 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 116415404 | 05 | TX | MEDICAID |