MEDICARE: DR. VAL ELBERT HADDON II DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	PO3491	FL
2	213ES0103X	Foot & Ankle Surgery Podiatrist	PO3491	FL

General Provider Information

NPI Number	:	1063659803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VAL ELBERT HADDON II DPM

Provider Business Mailing Address
First Line	:	2835 W DE LEON ST
Second Line	:	SUITE 101
City	:	TAMPA
State	:	FL
Zip	:	33609-4130
Country	:	US
Telephone Number	:	813-254-6592
Fax Number	:

Provider Business Practice Location Address
First Line	:	5637 49TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2105
Country	:	US
Telephone Number	:	727-384-5540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2009
Last Update Date	:	03/18/2013

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