Healthcare Provider Details

I. General information

NPI: 1396914693
Provider Name (Legal Business Name): DISEASE NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 REDWOOD DR
PASADENA CA
91105-1340
US

IV. Provider business mailing address

3440 HOLLYWOOD BLVD SUITE 460
HOLLYWOOD FL
33021-6927
US

V. Phone/Fax

Practice location:
  • Phone: 954-923-7440
  • Fax:
Mailing address:
  • Phone: 954-923-7440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateCA

VIII. Authorized Official

Name: G WILLIAM COURTRIGHT
Title or Position: CEO
Credential: MD
Phone: 954-923-7440