Provider Demographics
NPI:1699862599
Name:KOLMETZ, JOSHUA KALEB (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:KALEB
Last Name:KOLMETZ
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 1:369 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-3541
Mailing Address - Country:US
Mailing Address - Phone:850-398-6963
Mailing Address - Fax:
Practice Address - Street 1:369 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-3541
Practice Address - Country:US
Practice Address - Phone:850-398-6963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97211207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278944200Medicaid
FL95477OtherBCBS
FLAI315ZMedicare PIN
FLAI315YMedicare PIN