Healthcare Provider Details

I. General information

NPI: 1891431169
Provider Name (Legal Business Name): SOUTH FLORIDA FOOT & ANKLE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W INDIANTOWN RD STE 106
JUPITER FL
33458-3549
US

IV. Provider business mailing address

11412 OKEECHOBEE BLVD
ROYAL PALM BEACH FL
33411-8722
US

V. Phone/Fax

Practice location:
  • Phone: 561-793-6170
  • Fax:
Mailing address:
  • Phone: 561-793-6170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN M CUTLER
Title or Position: PRESIDENT
Credential: DPM
Phone: 561-793-6170