MEDICARE: CHARLES DEMELLO SCHUTT M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	ME150031	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497281471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES DEMELLO SCHUTT M.D

Provider Business Mailing Address
First Line	:	4205 BELFORT RD STE 4015
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-3623
Country	:	US
Telephone Number	:	904-450-6063
Fax Number	:	904-539-4091

Provider Business Practice Location Address
First Line	:	5153 N 9TH AVE STE 404
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32504-5707
Country	:	US
Telephone Number	:	850-416-2554
Fax Number	:	850-416-7442

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	09/15/2022

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