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General NPI Number Information
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NPI Number | 1447616495
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Entity Type | Organization
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Legal Business Name | FLORIDA ORTHOPEDIC FOOT & ANKLE CENTER LLC
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Dates
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Enumeration Date | 01/06/2016
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Last Update Date | 06/03/2019
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Provider Practice Location Address
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Address Line | 1630 S TUTTLE AVE STE A
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City | SARASOTA
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State | FL
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Zip | 34239-3108
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Country | US
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Telephone | 941-924-8777
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Fax |
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Provider Business Mailing Address
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Address Line | 1630 S TUTTLE AVE STE A
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City | SARASOTA
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State | FL
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Zip | 34239-3108
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Country | US
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Telephone | 941-924-8777
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES M COTTOM
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Credential |
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Telephone | 941-924-8777
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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 | PO3305
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License Number State | FL
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