=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205986973
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEAN LIFFITON DPM PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2007
-----------------------------------------------------
Last Update Date | 01/11/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5441 UNIVERSITY DR SUITE 102
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33067-4640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-345-8637
-----------------------------------------------------
Fax | 954-345-8694
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5441 UNIVERSITY DR SUITE 102
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33067-4640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-345-8637
-----------------------------------------------------
Fax | 954-345-8694
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SEAN LIFFITON
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 954-345-8637
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | PO-0002460
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------