Healthcare Provider Details

I. General information

NPI: 1558370395
Provider Name (Legal Business Name): BRIAN E MCCARTHY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 03/07/2023
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2858 MAHAN DR STE 1&2
TALLAHASSEE FL
32308-5446
US

IV. Provider business mailing address

3570 STROLLING WAY
TALLAHASSEE FL
32311-3767
US

V. Phone/Fax

Practice location:
  • Phone: 850-942-0096
  • Fax: 850-942-0090
Mailing address:
  • Phone: 352-238-4237
  • Fax: 850-942-0090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2298
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: