Provider Demographics
NPI:1033140264
Name:SCHULTZ, NEIL R (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:R
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 MEDICAL LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1129
Mailing Address - Country:US
Mailing Address - Phone:239-278-5700
Mailing Address - Fax:239-278-5786
Practice Address - Street 1:1630 MEDICAL LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1129
Practice Address - Country:US
Practice Address - Phone:239-278-5700
Practice Address - Fax:239-278-5786
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066740174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27151AMedicare ID - Type Unspecified
FLE71521Medicare UPIN