Healthcare Provider Details

I. General information

NPI: 1366999252
Provider Name (Legal Business Name): SAVING SOLES PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 HIGHWAY 466
LADY LAKE FL
32159-3926
US

IV. Provider business mailing address

PO BOX 490552
LEESBURG FL
34749-0552
US

V. Phone/Fax

Practice location:
  • Phone: 352-255-3302
  • Fax:
Mailing address:
  • Phone: 352-255-3302
  • Fax: 352-354-9920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO3579
License Number StateFL

VIII. Authorized Official

Name: DR. DAVID JASON HANCOCK
Title or Position: OWNER/PHYSICIAN
Credential: DPM
Phone: 352-255-3302