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General NPI Number Information
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NPI Number | 1194725002
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Entity Type | Organization
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Legal Business Name | FOOT & ANKLE GROUP OF SOUTHWEST FLORIDA, PA
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 7117 CONGDON RD APT 200
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City | FORT MYERS
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State | FL
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Zip | 33908-5004
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Country | US
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Telephone | 239-936-5400
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Fax | 239-936-9572
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Provider Business Mailing Address
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Address Line | 7117 CONGDON RD APT 200
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City | FORT MYERS
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State | FL
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Zip | 33908-5004
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Country | US
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Telephone | 239-936-5400
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Fax | 239-936-9572
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JEROLD S. GOLDSTEIN
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Credential |
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Telephone | 239-936-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | 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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO-1326
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO-2020
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO-1693
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO-3722
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO-3613
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License Number State | FL
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