Provider Demographics
NPI:1215919220
Name:SHULER, FREDERICK W (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:W
Last Name:SHULER
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 1:11945 SAN JOSE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1627
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-396-4893
Practice Address - Street 1:1836 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4639
Practice Address - Country:US
Practice Address - Phone:850-872-8510
Practice Address - Fax:850-872-7412
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88381174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81007OtherBCBS
FLH92759Medicare UPIN
FL81007OtherBCBS
FL81007YMedicare ID - Type UnspecifiedFREDERICK W, SHULER