Healthcare Provider Details

I. General information

NPI: 1366628075
Provider Name (Legal Business Name): ERIC W SHULTZ DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 BEACH BLVD
JACKSONVILLE BEACH FL
32250-3405
US

IV. Provider business mailing address

2236 PARK ST
JACKSONVILLE FL
32204-4316
US

V. Phone/Fax

Practice location:
  • Phone: 904-389-0346
  • Fax: 904-246-5449
Mailing address:
  • Phone: 904-389-0346
  • Fax: 904-389-1142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO1898
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License NumberPO1898
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO1898
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberPO1898
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberPO1898
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO1898
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO1898
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: