Healthcare Provider Details

I. General information

NPI: 1124266846
Provider Name (Legal Business Name): EIGHTH STREET FOOT AND ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 W MONROE ST STE 101
JACKSONVILLE FL
32204-1177
US

IV. Provider business mailing address

915 W MONROE ST STE 101
JACKSONVILLE FL
32204-1177
US

V. Phone/Fax

Practice location:
  • Phone: 904-355-1553
  • Fax: 904-356-7774
Mailing address:
  • Phone: 904-355-1553
  • Fax: 904-356-7774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3181
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN GERALD HARRIS JR.
Title or Position: OWNER
Credential: DPM
Phone: 904-355-1553