Healthcare Provider Details

I. General information

NPI: 1922081645
Provider Name (Legal Business Name): NEAL R MORTENSEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 W CENTRAL PKWY STE 1000
ALTAMONTE SPRINGS FL
32714-2433
US

IV. Provider business mailing address

450 W CENTRAL PKWY STE 1000
ALTAMONTE SPRINGS FL
32714-2433
US

V. Phone/Fax

Practice location:
  • Phone: 321-397-2699
  • Fax: 407-926-0500
Mailing address:
  • Phone: 321-397-2699
  • Fax: 407-926-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3214
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: