Healthcare Provider Details

I. General information

NPI: 1841227741
Provider Name (Legal Business Name): ORLANDO FOOT AND ANKLE CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 S ORANGE AVE STE 100
ORLANDO FL
32806
US

IV. Provider business mailing address

P O BOX 140233
ORLANDO FL
32814-0233
US

V. Phone/Fax

Practice location:
  • Phone: 407-649-1234
  • Fax: 407-422-6476
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 StateFL
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number800028517
License Number StateFL

VIII. Authorized Official

Name: GREGORY JOSEPH RENTON
Title or Position: CEO
Credential:
Phone: 407-219-5400