=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245035823
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH FLORIDA FOOT & ANKLE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2025
-----------------------------------------------------
Last Update Date | 02/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 S MAIN ST
-----------------------------------------------------
City | BELLE GLADE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33430-4910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-993-9968
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11412 OKEECHOBEE BLVD
-----------------------------------------------------
City | ROYAL PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33411-8722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-793-6170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JONATHAN M CUTLER
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 561-793-6170
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------