Provider Demographics
NPI: | 1033198965 |
---|---|
Name: | STRITTMATTER, JUSTIN (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | JUSTIN |
Middle Name: | |
Last Name: | STRITTMATTER |
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: | PO BOX 9167 |
Mailing Address - Street 2: | |
Mailing Address - City: | PANAMA CITY BEACH |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32417-9167 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 850-665-3653 |
Mailing Address - Fax: | 850-665-3654 |
Practice Address - Street 1: | 615 N BONITA AVE |
Practice Address - Street 2: | EMERGENCY DEPARTMENT |
Practice Address - City: | PANAMA CITY |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32401-3623 |
Practice Address - Country: | US |
Practice Address - Phone: | 850-747-6000 |
Practice Address - Fax: | 850-747-6323 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-01-10 |
Last Update Date: | 2012-07-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME0092292 | 207P00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
GA | 254305183A | Medicaid | |
FL | 52413 | Other | BCBS |
FL | 271626700 | Medicaid | |
GA | 254305183A | Medicaid | |
FL | H85001 | Medicare UPIN | |
FL | 52413 | Other | BCBS |
FL | 52413X | Medicare PIN |