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General NPI Number Information
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NPI Number | 1356721278
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Entity Type | Organization
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Legal Business Name | ORLANDO FOOT & ANKLE CLINIC, INC
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Dates
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Enumeration Date | 06/05/2015
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 160 ISLANDER CT
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City | LONGWOOD
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State | FL
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Zip | 32750
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Country | US
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Telephone | 407-423-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 3165 MCCRORY PL STE 174
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City | ORLANDO
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State | FL
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Zip | 32803-3727
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Country | US
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Telephone | 407-423-1234
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Fax | 407-517-1040
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Authorized Official
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Title or Position | CEO
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Name | GREGORY RENTON
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Credential |
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Telephone | 407-423-1234
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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 |
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License Number State |
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