Healthcare Provider Details

I. General information

NPI: 1831163740
Provider Name (Legal Business Name): DOUGLAS M CHILDS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N PARK AVE SUITE 500
APOPKA FL
32703
US

IV. Provider business mailing address

3165 MCCRORY PL SUITE 174
ORLANDO FL
32803-3771
US

V. Phone/Fax

Practice location:
  • Phone: 407-410-1234
  • Fax: 407-410-0149
Mailing address:
  • Phone: 407-423-1234
  • Fax: 407-517-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO 2841
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: