Healthcare Provider Details

I. General information

NPI: 1255394540
Provider Name (Legal Business Name): JOEL SCHOLTEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 BRUCE B DOWNS BLVD DEPT RMS (117)
TAMPA FL
33612-4745
US

IV. Provider business mailing address

13000 BRUCE B DOWNS BLVD DEPT RMS (117)
TAMPA FL
33612-4745
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-7506
  • Fax:
Mailing address:
  • Phone: 813-972-7506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME 73312
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: