Basic Information
| Provider Information | |||||||||
| NPI: | 1952716508 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHUTZBACH | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2995 DREW ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337593012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275321355 | ||||||||
| FaxNumber: | 8136352613 | ||||||||
| Practice Location | |||||||||
| Address1: | 7751 9TH ST N STE 10 | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337021102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275212424 | ||||||||
| FaxNumber: | 7275212425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2014 | ||||||||
| LastUpdateDate: | 03/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 36872 | SC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | MD461314 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207Q00000X | ME140165 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 105027500 | 05 | FL | MEDICAID |