Provider Demographics
NPI:1851303903
Name:SCHULZ, STACY NORMAN (MD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:NORMAN
Last Name:SCHULZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6755
Mailing Address - Street 2:212 CARLANNA RD #201
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-1755
Mailing Address - Country:US
Mailing Address - Phone:907-247-3301
Mailing Address - Fax:907-247-3306
Practice Address - Street 1:212 CARLANNA LAKE RD STE 201
Practice Address - Street 2:BOX 6755
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5642
Practice Address - Country:US
Practice Address - Phone:907-247-3301
Practice Address - Fax:907-247-3306
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2604207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK2604OtherSTATE MD LICENSE
AKMD13202Medicaid
AKD26277Medicare UPIN
AKMD13202Medicaid
K152272Medicare PIN
AK2604OtherSTATE MD LICENSE