Provider Demographics
NPI:1194766238
Name:SHULTS, WILLIAM THOMAS I (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:SHULTS
Suffix:I
Gender:M
Credentials:MD
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Mailing Address - Street 1:3827 SW 48TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2105
Mailing Address - Country:US
Mailing Address - Phone:503-292-8285
Mailing Address - Fax:503-413-6937
Practice Address - Street 1:1040 NW 22ND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3057
Practice Address - Country:US
Practice Address - Phone:503-413-8032
Practice Address - Fax:503-413-6937
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD07886207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC91061Medicare UPIN