Healthcare Provider Details

I. General information

NPI: 1982934626
Provider Name (Legal Business Name): CORY B HAIMON, D.P.M., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 12/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 S BARFIELD HWY SUITE 106
PAHOKEE FL
33476-1868
US

IV. Provider business mailing address

7431 W ATLANTIC AVE STE 33
DELRAY BEACH FL
33446-3505
US

V. Phone/Fax

Practice location:
  • Phone: 561-692-9024
  • Fax: 561-496-5348
Mailing address:
  • Phone: 561-496-6900
  • Fax: 561-496-5348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO0001689
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO0001592
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier390417200
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer

VIII. Authorized Official

Name: TAMMY S ROSE
Title or Position: OFFICE MANAGER
Credential:
Phone: 561-496-6900