Healthcare Provider Details

I. General information

NPI: 1477380020
Provider Name (Legal Business Name): FRONT RUNNER FOOT AND ANKLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7651 ASHLEY PARK CT STE 408
ORLANDO FL
32835-6114
US

IV. Provider business mailing address

3070 IRISH PEACH DR
WINTER GARDEN FL
34787-5674
US

V. Phone/Fax

Practice location:
  • Phone: 910-233-4795
  • Fax:
Mailing address:
  • Phone: 910-233-4795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. THANH CONG VAN
Title or Position: FOUNDER AND CEO
Credential: DPM
Phone: 910-233-4795