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General NPI Number Information
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NPI Number | 1255152351
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Entity Type | Organization
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Legal Business Name | OUTREACH FOOT CARE LLC
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 8051 N TAMIAMI TRL STE E6
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City | SARASOTA
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State | FL
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Zip | 34243-2067
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Country | US
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Telephone | 573-979-1809
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Fax | 888-523-2655
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Provider Business Mailing Address
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Address Line | 8051 N TAMIAMI TRL STE E6
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City | SARASOTA
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State | FL
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Zip | 34243-2067
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Country | US
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Telephone | 573-979-1809
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Fax | 888-523-2655
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT M DAUGHERTY
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Credential | DPM
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Telephone | 573-979-1809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number |
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License Number State |
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