MEDICARE: ERIC W SHULTZ DPM

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	213E00000X	Podiatrist	PO1898	FL
2	213EP0504X	Public Medicine Podiatrist	PO1898	FL
3	213EP1101X	Primary Podiatric Medicine Podiatrist	PO1898	FL
4	213ER0200X	Radiology Podiatrist	PO1898	FL
5	213ES0000X	Sports Medicine Podiatrist	PO1898	FL
6	213ES0103X	Foot & Ankle Surgery Podiatrist	PO1898	FL
7	213ES0131X	Foot Surgery Podiatrist	PO1898	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	480020923	OTHER	FL	MEDICARE RAILROAD

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
3	65159	OTHER	FL	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366628075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC W SHULTZ DPM

Provider Business Mailing Address
First Line	:	2236 PARK ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4316
Country	:	US
Telephone Number	:	904-389-0346
Fax Number	:	904-389-1142

Provider Business Practice Location Address
First Line	:	1205 BEACH BLVD
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3405
Country	:	US
Telephone Number	:	904-389-0346
Fax Number	:	904-246-5449

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

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	04/03/2017

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Directions to “ ERIC W SHULTZ DPM” Practice Location

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