Healthcare Provider Details

I. General information

NPI: 1922370618
Provider Name (Legal Business Name): ADLER PODIATRY CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3316 3RD ST S STE 201
JACKSONVILLE BEACH FL
32250-6073
US

IV. Provider business mailing address

3636 UNIVERSITY BLVD S BLDG C
JACKSONVILLE FL
32216-4250
US

V. Phone/Fax

Practice location:
  • Phone: 904-731-1711
  • Fax: 904-731-9270
Mailing address:
  • Phone: 904-731-1711
  • Fax: 904-731-9270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CARRIE GUENTHER
Title or Position: OFFICE MANAGER
Credential:
Phone: 904-731-1711