Healthcare Provider Details

I. General information

NPI: 1578696878
Provider Name (Legal Business Name): PODIATRY & BAREFOOT WELLNESS CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 BEACH BLVD
JACKSONVILLE BEACH FL
32250-3405
US

IV. Provider business mailing address

1205 BEACH BLVD
JACKSONVILLE BEACH FL
32250-3405
US

V. Phone/Fax

Practice location:
  • Phone: 904-389-0346
  • Fax: 904-246-5449
Mailing address:
  • Phone: 904-389-0346
  • Fax: 904-246-5449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. HOWARD J GROSHELL
Title or Position: PRESIDENT DIRECTOR
Credential: DPM
Phone: 904-389-0346