Provider Demographics
NPI:1194746966
Name:POLITZ, DOUGLAS E (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:E
Last Name:POLITZ
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:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-844-7000
Mailing Address - Fax:
Practice Address - Street 1:409 BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2707
Practice Address - Country:US
Practice Address - Phone:813-844-8335
Practice Address - Fax:813-844-1655
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 94991208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275035000Medicaid
MS01323079Medicaid
MS01323079Medicaid
FLK9281Medicare PIN
FLH23428Medicare UPIN
FL275035000Medicaid
FL35230ZMedicare ID - Type Unspecified