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General NPI Number Information
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NPI Number | 1356625297
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Entity Type | Organization
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Legal Business Name | ST PETERSBURG DIABETIC & ARTHRITIC FOOT CENTER PA
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 09/30/2014
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Provider Practice Location Address
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Address Line | 4200 CENTRAL AVE
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City | ST PETERSBURG
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State | FL
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Zip | 33711-1140
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Country | US
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Telephone | 727-321-8806
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Fax | 727-321-6838
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Provider Business Mailing Address
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Address Line | 4200 CENTRAL AVE
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City | ST PETERSBURG
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State | FL
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Zip | 33711-1140
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Country | US
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Telephone | 727-321-8806
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Fax | 727-321-6838
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Authorized Official
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Title or Position | PRESIDENT/PODIATRIST
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Name | DR. DARALL J MOORE
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Credential | DPM
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Telephone | 727-321-8806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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