=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437337649
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALBERT C DENAULT II DPM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2008
-----------------------------------------------------
Last Update Date | 09/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 311 MANATEE AVE E
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34208-1933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-749-0626
-----------------------------------------------------
Fax | 941-749-0618
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 311 MANATEE AVE E
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34208-1933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-749-0626
-----------------------------------------------------
Fax | 941-749-0618
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ALBERT C. DENAULT II
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 941-749-0626
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | PO2367
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------