Provider Demographics
NPI:1366461097
Name:SCHULTZ, JESS MORGAN (MD)
Entity type:Individual
Prefix:
First Name:JESS
Middle Name:MORGAN
Last Name:SCHULTZ
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 1:1400 E KINCAID ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 S 14TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4117
Practice Address - Country:US
Practice Address - Phone:360-814-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046312208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8943481OtherCRIME VICTIMS
WA0217205OtherLABOR & INDUSTRIES
OR149992Medicaid
WA8205411Medicaid
WA8457780Medicaid
OR026444Medicaid
WA8943530OtherCRIME VICTIMS
WA0217054OtherL & I
WA8943481OtherCRIME VICTIMS
OR026444Medicaid
OR149992Medicaid