Provider Demographics
NPI:1326250010
Name:ERIC W SHULTZ DPM PA
Entity Type:Organization
Organization Name:ERIC W SHULTZ DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUNDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:904-551-1765
Mailing Address - Street 1:10250 NORMANDY BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-0000
Mailing Address - Country:US
Mailing Address - Phone:904-551-1765
Mailing Address - Fax:904-527-3857
Practice Address - Street 1:10250 NORMANDY BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-0000
Practice Address - Country:US
Practice Address - Phone:904-551-1765
Practice Address - Fax:904-388-8263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1898213E00000X, 213EP0504X, 213EP1101X, 213ER0200X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic MedicineGroup - Single Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390193900Medicaid
FL480020923OtherMEDICARE RAILROAD
FL65159OtherBLUE CROSS BLUE SHIELD
FLU10379Medicare UPIN
FL65159Medicare PIN
FL390193900Medicaid