Provider Demographics
NPI:1366628075
Name:SHULTZ, ERIC W (DPM)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:W
Last Name:SHULTZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 PARK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4316
Mailing Address - Country:US
Mailing Address - Phone:904-389-0346
Mailing Address - Fax:904-389-1142
Practice Address - Street 1:1205 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3405
Practice Address - Country:US
Practice Address - Phone:904-389-0346
Practice Address - Fax:904-246-5449
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1898213E00000X, 213EP0504X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390193900Medicaid
FL480020923OtherMEDICARE RAILROAD
FL65159OtherBLUE CROSS BLUE SHIELD
FLU10379Medicare UPIN
FL65159OtherBLUE CROSS BLUE SHIELD
FL480020923OtherMEDICARE RAILROAD
FL0915530001Medicare NSC
FLEA246AMedicare PIN