Healthcare Provider Details

I. General information

NPI: 1346294576
Provider Name (Legal Business Name): JAMES T CLANCY D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 JFK DR
ATLANTIS FL
33462-6641
US

IV. Provider business mailing address

180 JFK DR
ATLANTIS FL
33462-6641
US

V. Phone/Fax

Practice location:
  • Phone: 561-967-6500
  • Fax:
Mailing address:
  • Phone: 561-967-6500
  • Fax: 561-423-4687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO1903
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: