Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO1898 | FL |
Y | 222Z00000X | Podiatrist | PO1898 | FL |
N | 213EP0504X | Public Medicine | PO1898 | FL |
N | 213EP1101X | Primary Podiatric Medicine | PO1898 | FL |
N | 111NR0200X | Radiology | PO1898 | FL |
N | 213ER0200X | Radiology | PO1898 | FL |
N | 2081S0010X | Sports Medicine | PO1898 | FL |
N | 213ES0000X | Sports Medicine | PO1898 | FL |
N | 213ES0103X | Foot & Ankle Surgery | PO1898 | FL |
N | 213ES0131X | Foot Surgery | PO1898 | FL |
NPI | 1366628075 |
---|---|
Provider Name | Eric W Shultz |
First Address | Jacksonville, FL 32204-4316 |
Second Address | Jacksonville Beach, FL 32250-3405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2008 |
Last Update Date | 03/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
390193900 | (05) | FL |
480020923 | MEDICARE RAILROAD (01) | FL |
65159 | BLUE CROSS BLUE SHIELD (01) | FL |
U10379 | (02) | |
U10379 | (02) | FL |