Provider Demographics
NPI:1144290677
Name:FOLTZ, JERRY RICHARD II (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:RICHARD
Last Name:FOLTZ
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:FOLTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 734905
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-4905
Mailing Address - Country:US
Mailing Address - Phone:904-449-7246
Mailing Address - Fax:904-719-7571
Practice Address - Street 1:4796 HODGES BLVD
Practice Address - Street 2:SUITE 101-104
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224
Practice Address - Country:US
Practice Address - Phone:904-449-7246
Practice Address - Fax:904-719-7571
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 95194207LP2900X
FLME95194208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100386600Medicaid