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General NPI Number Information
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NPI Number | 1477898690
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Entity Type | Organization
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Legal Business Name | ELITE FOOT & ANKLE SPECIALITSTS, LLC
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Dates
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Enumeration Date | 11/28/2012
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 15740 NEW HAMPSHIRE CT SUITE B
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City | FORT MYERS
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State | FL
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Zip | 33908-4173
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Country | US
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Telephone | 239-689-5130
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Fax |
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Provider Business Mailing Address
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Address Line | 15740 NEW HAMPSHIRE CT SUITE B
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City | FORT MYERS
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State | FL
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Zip | 33908-4173
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Country | US
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Telephone | 239-689-5130
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOB TIMENY
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Credential | DPM
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Telephone | 239-689-5130
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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 | PO3490
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License Number State | FL
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