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General NPI Number Information
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NPI Number | 1023557204
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Entity Type | Organization
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Legal Business Name | FLORIDA FOOT & ANKLE GROUP PA
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 178 WILSHIRE BLVD
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City | CASSELBERRY
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State | FL
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Zip | 32707-5352
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Country | US
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Telephone | 407-671-8010
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Fax | 407-671-4155
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Provider Business Mailing Address
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Address Line | 522 S HUNT CLUB BLVD # 344
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City | APOPKA
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State | FL
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Zip | 32703-4960
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Country | US
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Telephone | 407-297-9800
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Fax | 407-296-6272
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Authorized Official
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Title or Position | TREASURER
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Name | DR. WALTER E ROTH III
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Credential | D.P.M.
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Telephone | 407-323-2566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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