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General NPI Number Information
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NPI Number | 1235916123
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Entity Type | Organization
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Legal Business Name | ST. AUGUSTINE FOOT & ANKLE, INC
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Dates
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Enumeration Date | 09/13/2023
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Last Update Date | 09/30/2023
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Provider Practice Location Address
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Address Line | 1 SAINT JOHNS MEDICAL PARK DR
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5300
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Country | US
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Telephone | 904-824-0869
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Fax |
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Provider Business Mailing Address
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Address Line | 1 SAINT JOHNS MEDICAL PARK DR
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5300
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Country | US
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Telephone | 904-824-0869
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MIA CONNOR
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Credential |
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Telephone | 904-824-0869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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