Healthcare Provider Details

I. General information

NPI: 1326250010
Provider Name (Legal Business Name): ERIC W SHULTZ DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10250 NORMANDY BLVD SUITE 205
JACKSONVILLE FL
32221-0000
US

IV. Provider business mailing address

10250 NORMANDY BLVD SUITE 205
JACKSONVILLE FL
32221-0000
US

V. Phone/Fax

Practice location:
  • Phone: 904-551-1765
  • Fax: 904-388-8263
Mailing address:
  • Phone: 904-551-1765
  • Fax: 904-527-3857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. KELLEY M LUNDEEN
Title or Position: OFFICE MANAGER
Credential: DPM
Phone: 904-551-1765