Provider Demographics
NPI:1457336190
Name:SCHULTZ, BARRY MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:MICHAEL
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 1:13550 JOG ROAD
Mailing Address - Street 2:STE 204
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2366
Mailing Address - Country:US
Mailing Address - Phone:561-637-1453
Mailing Address - Fax:561-637-1457
Practice Address - Street 1:13550 JOG ROAD
Practice Address - Street 2:STE 204
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2366
Practice Address - Country:US
Practice Address - Phone:561-637-1453
Practice Address - Fax:561-637-1457
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067047207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0067047OtherLICENSE NUMBER
FLA61952Medicare UPIN
FLME0067047OtherLICENSE NUMBER