Healthcare Provider Details

I. General information

NPI: 1649409756
Provider Name (Legal Business Name): ST. AUGUSTINE FOOT & ANKLE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 09/30/2023
Certification Date: 09/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT JOHNS MEDICAL PARK DR
ST AUGUSTINE FL
32086-5300
US

IV. Provider business mailing address

1 SAINT JOHNS MEDICAL PARK DR
ST AUGUSTINE FL
32086-5300
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-0869
  • Fax: 904-826-0966
Mailing address:
  • Phone: 904-824-0869
  • Fax: 904-826-0966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS A LEBEAU
Title or Position: OWNER
Credential: D.P.M.
Phone: 904-824-0869