Healthcare Provider Details

I. General information

NPI: 1992779920
Provider Name (Legal Business Name): EDMUND CORRY MAGUIRE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: E CORRY MAGUIRE DPM

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 BLACKWOOD AVE
OCOEE FL
34761-4521
US

IV. Provider business mailing address

3165 MCCRORY PL STE 174
ORLANDO FL
32803-3727
US

V. Phone/Fax

Practice location:
  • Phone: 407-877-2900
  • Fax: 407-877-0193
Mailing address:
  • Phone: 407-423-1234
  • Fax: 407-517-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO 2783
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: