Healthcare Provider Details

I. General information

NPI: 1508887704
Provider Name (Legal Business Name): AMBULATORY ANKLE & FOOT CENTER OF FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 S ORANGE AVE
ORLANDO FL
32806-2116
US

IV. Provider business mailing address

3670 MAGUIRE BLVD SUITE 220
ORLANDO FL
32803-3071
US

V. Phone/Fax

Practice location:
  • Phone: 407-836-6155
  • Fax: 407-839-0189
Mailing address:
  • Phone: 407-423-1234
  • Fax: 407-517-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number740
License Number StateFL

VIII. Authorized Official

Name: GREGORY J RENTON
Title or Position: CEO
Credential:
Phone: 407-423-1234