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General NPI Number Information
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NPI Number | 1366420606
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Entity Type | Organization
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Legal Business Name | LAKELAND FOOT & ANKLE CENTER PA
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Dates
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Enumeration Date | 01/06/2006
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Last Update Date | 03/03/2010
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Provider Practice Location Address
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Address Line | 1543 LAKELAND HILLS BLVD STE B
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City | LAKELAND
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State | FL
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Zip | 33805-3246
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Country | US
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Telephone | 863-682-3395
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Fax | 863-802-1225
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Provider Business Mailing Address
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Address Line | 1543 LAKELAND HILLS BLVD STE B
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City | LAKELAND
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State | FL
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Zip | 33805-3246
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Country | US
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Telephone | 863-682-3395
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Fax | 863-802-1225
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREGORY G COOK
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Credential | DPM
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Telephone | 863-682-3395
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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 | PO0002468
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License Number State | FL
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