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General NPI Number Information
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NPI Number | 1306032586
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Entity Type | Organization
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Legal Business Name | PODIATRY ASSOCIATES OF FLORIDA INC
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 09/03/2009
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Provider Practice Location Address
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Address Line | 220 SOUTHPARK CIR E
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5135
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Country | US
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Telephone | 904-829-2855
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Fax | 904-829-0672
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Provider Business Mailing Address
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Address Line | 3117 SPRING GLEN RD STE 402
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5906
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Country | US
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Telephone | 904-224-2001
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Fax | 904-224-2002
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Authorized Official
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Title or Position | BUSINESS ADMINISTRATOR
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Name | SUSAN G SINCHUK
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Credential |
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Telephone | 904-224-2001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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