Healthcare Provider Details

I. General information

NPI: 1144338484
Provider Name (Legal Business Name): ORLANDO FOOT AND ANKLE CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7148 CURRY FORD RD # 300
ORLANDO FL
32822
US

IV. Provider business mailing address

P O BOX 140233
ORLANDO FL
32814-0233
US

V. Phone/Fax

Practice location:
  • Phone: 407-275-5440
  • Fax: 407-282-4008
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 Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number800028517
License Number StateFL

VIII. Authorized Official

Name: GREGORY RENTON
Title or Position: CEO
Credential:
Phone: 407-523-1234