Healthcare Provider Details

I. General information

NPI: 1336109024
Provider Name (Legal Business Name): PHILIP FRED ADLER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 UNIVERSITY BLVD S BLDG C
JACKSONVILLE FL
32216-4250
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 Code213E00000X
TaxonomyPodiatrist
License NumberPO0000690
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: