MEDICARE: ANKLE & FOOT CENTER OF TAMPA BAY

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	97860	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1265419964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANKLE & FOOT CENTER OF TAMPA BAY

Provider Business Mailing Address
First Line	:	2835 W DE LEON ST
Second Line	:	SUITE 101
City	:	TAMPA
State	:	FL
Zip	:	33609-4168
Country	:	US
Telephone Number	:	813-254-6592
Fax Number	:	813-254-3634

Provider Business Practice Location Address
First Line	:	2835 W DE LEON ST
Second Line	:	SUITE 101
City	:	TAMPA
State	:	FL
Zip	:	33609-4168
Country	:	US
Telephone Number	:	813-254-6592
Fax Number	:	813-254-3634

Authorized Official
Title or Position	:	MEMBER
Name	:	ROBERT E CREIGHTON
Credential	:	DPM
Telephone Number	:	813-254-4747

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	10/11/2018

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Directions to “ANKLE & FOOT CENTER OF TAMPA BAY ” Practice Location

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