Provider Demographics
NPI:1427096262
Name:SCHANTZ, MATTHEW E (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:E
Last Name:SCHANTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-0307
Mailing Address - Country:US
Mailing Address - Phone:931-853-6136
Mailing Address - Fax:931-853-6137
Practice Address - Street 1:206 S MILITARY ST
Practice Address - Street 2:
Practice Address - City:LORETTO
Practice Address - State:TN
Practice Address - Zip Code:38469-2101
Practice Address - Country:US
Practice Address - Phone:931-853-6136
Practice Address - Fax:931-853-6137
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37065TN207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH83539Medicare UPIN