Provider Demographics
NPI:1063839421
Name:SHULTZ, JOSHUA RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:RUSSELL
Last Name:SHULTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 MEDICAL PLAZA DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1047
Mailing Address - Country:US
Mailing Address - Phone:407-871-5120
Mailing Address - Fax:
Practice Address - Street 1:1403 MEDICAL PLAZA DR STE 102
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1047
Practice Address - Country:US
Practice Address - Phone:407-871-5120
Practice Address - Fax:407-330-9949
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine