Provider Demographics
NPI:1962804542
Name:SCHULTHEIS, ERIC
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:SCHULTHEIS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ERIC
Other - Middle Name:
Other - Last Name:SCHULTHEIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:4THYR MS
Mailing Address - Street 1:623 AVENUE E
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-1925
Mailing Address - Country:US
Mailing Address - Phone:504-957-7589
Mailing Address - Fax:
Practice Address - Street 1:623 AVENUE E
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-1925
Practice Address - Country:US
Practice Address - Phone:504-957-7569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA174H00000X, 174V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174V00000XOther Service ProvidersClinical Ethicist
No174H00000XOther Service ProvidersHealth Educator