Provider Demographics
NPI:1316446339
Name:BROOKINGS INTERNAL MEDICINE-PATHOLOGY-DISEASES OF THE SKIN
Entity type:Organization
Organization Name:BROOKINGS INTERNAL MEDICINE-PATHOLOGY-DISEASES OF THE SKIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-254-9424
Mailing Address - Street 1:97839 SHOPPING CENTER AVE # 7229
Mailing Address - Street 2:
Mailing Address - City:HARBOR
Mailing Address - State:OR
Mailing Address - Zip Code:97415-9403
Mailing Address - Country:US
Mailing Address - Phone:541-254-9424
Mailing Address - Fax:541-254-9425
Practice Address - Street 1:97839 SHOPPING CENTER AVE # 7229
Practice Address - Street 2:
Practice Address - City:HARBOR
Practice Address - State:OR
Practice Address - Zip Code:97415-9403
Practice Address - Country:US
Practice Address - Phone:541-254-9424
Practice Address - Fax:541-254-9425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD126149207ZP0102X, 207N00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty