Provider Demographics
NPI:1306984679
Name:SCHUTT, RICHARD C (PAC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:SCHUTT
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4780 N JOSEY LANE
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010
Mailing Address - Country:US
Mailing Address - Phone:972-492-1334
Mailing Address - Fax:972-395-2219
Practice Address - Street 1:4780 N JOSEY LANE
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010
Practice Address - Country:US
Practice Address - Phone:972-492-1334
Practice Address - Fax:972-395-2219
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002869363A00000X
TXPA05910363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0739010002OtherMEDICARE NSC
TX6484850003OtherMEDICARE NSC - EFFECT 02/01/2011
IL0739010003OtherMEDICARE NSC
IL208592OtherMEDICARE LOCALITY 99
TX835N08OtherBC/BS TX - EFFECT 02/01/2011
TX8Y9532OtherBLUE CROSS BLUE SHIELD
ILP00477787OtherRAILROAD MEDICARE PTAN
IL208887OtherMEDICARE LOCALITY 15
TXP00935332OtherRAILROAD MEDICARE
IL0739010008OtherMEDICARE NSC
IL0739010006OtherMEDICARE NSC
ILCD4744OtherRAILROAD MEDICARE GROUP #
IL0739010001OtherMEDICARE NSC
IL0739010004OtherMEDICARE NSC
IL0739010005OtherMEDICARE NSC
IL0739010010OtherMEDICARE NSC
TXTXB128138OtherMEDICARE PART B - EFFECT. 05/03/2011
IL085002869OtherST. OF IL LICENSE
IL385001696OtherCONTROLLED SUBSTANCE
IL385001696OtherCONTROLLED SUBSTANCE
TX8Y9532OtherBLUE CROSS BLUE SHIELD
IL0739010010OtherMEDICARE NSC
ILCD4744OtherRAILROAD MEDICARE GROUP #
ILMS1530650OtherDEA