Healthcare Provider Details

I. General information

NPI: 1689010837
Provider Name (Legal Business Name): DALE R MONAST DPM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 W BAY DR
LARGO FL
33770-3002
US

IV. Provider business mailing address

1680 W BAY DR
LARGO FL
33770-3002
US

V. Phone/Fax

Practice location:
  • Phone: 727-586-3668
  • Fax: 727-588-0490
Mailing address:
  • Phone: 727-586-3668
  • Fax: 727-588-0490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO1709
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. DALE R MONAST
Title or Position: MANAGER
Credential: DPM
Phone: 727-586-3668