Healthcare Provider Details

I. General information

NPI: 1073886685
Provider Name (Legal Business Name): FEITZ FOOT CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 6TH ST
MARIANNA FL
32446-1930
US

IV. Provider business mailing address

2424 FRANKFORD AVE
PANAMA CITY FL
32405-2239
US

V. Phone/Fax

Practice location:
  • Phone: 850-784-9787
  • Fax: 850-784-9619
Mailing address:
  • Phone: 850-784-9787
  • Fax: 850-784-9619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO-2094
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO-2094
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO-2094
License Number StateFL

VIII. Authorized Official

Name: DR. DANIEL EUGENE FEITZ
Title or Position: OWNER
Credential: PODIATRY
Phone: 850-784-9787