Healthcare Provider Details

I. General information

NPI: 1154320539
Provider Name (Legal Business Name): JACK EDWARD RESSLER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 LINTON BLVD SUITE B5
DELRAY BEACH FL
33484-6596
US

IV. Provider business mailing address

1440 CORAL RIDGE DR SUITE 333
CORAL SPRINGS FL
33071-5433
US

V. Phone/Fax

Practice location:
  • Phone: 561-955-0405
  • Fax: 954-752-0197
Mailing address:
  • Phone: 561-955-0405
  • Fax: 954-752-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0001620
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: