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General NPI Number Information
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NPI Number | 1295264224
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Entity Type | Organization
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Legal Business Name | PODIATRIST ON CALL, LLC
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Dates
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Enumeration Date | 06/04/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2720 PARK ST STE 210
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City | JACKSONVILLE
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State | FL
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Zip | 32205-7645
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Country | US
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Telephone | 904-707-8769
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Fax | 844-663-5325
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Provider Business Mailing Address
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Address Line | 1560 LANCASTER TER APT 206
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4116
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Country | US
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Telephone | 904-707-8769
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Fax | 844-663-5325
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Authorized Official
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Title or Position | MANAGER
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Name | DR. TROY ADAM HARRIS
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Credential | DPM
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Telephone | 904-707-8769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3922
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License Number State | FL
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