Healthcare Provider Details

I. General information

NPI: 1467073049
Provider Name (Legal Business Name): ATLANTIC PODIATRY ASSOCIATES DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 DUNLAWTON AVE STE C
PORT ORANGE FL
32127-4222
US

IV. Provider business mailing address

1890 LPGA BLVD STE 230
DAYTONA BEACH FL
32117-7131
US

V. Phone/Fax

Practice location:
  • Phone: 386-788-6333
  • Fax: 386-788-3993
Mailing address:
  • Phone: 386-274-3336
  • Fax: 386-274-3660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: JAMES W RUST
Title or Position: PHYSICIAN
Credential:
Phone: 386-274-3336