Healthcare Provider Details

I. General information

NPI: 1891872313
Provider Name (Legal Business Name): BUXMONT PODIATRY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 YORK RD
WARMINSTER PA
18974-4516
US

IV. Provider business mailing address

399 YORK RD
WARMINSTER PA
18974-4516
US

V. Phone/Fax

Practice location:
  • Phone: 215-672-3222
  • Fax: 215-672-6634
Mailing address:
  • Phone: 215-672-3222
  • Fax: 215-672-6634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberSC001284L
License Number StatePA

VIII. Authorized Official

Name: DR. JACK B. GORMAN
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 215-672-3222