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General NPI Number Information
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NPI Number | 1528005063
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Entity Type | Organization
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Legal Business Name | WEST COAST PODIATRY CENTER, INC.
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 1611 53RD AVE W
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City | BRADENTON
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State | FL
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Zip | 34207-2868
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Country | US
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Telephone | 941-753-9599
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Fax | 941-755-0261
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Provider Business Mailing Address
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Address Line | 1611 53RD AVE W
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City | BRADENTON
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State | FL
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Zip | 34207-2868
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Country | US
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Telephone | 941-753-9599
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Fax | 941-755-0261
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN D LASDAY
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Credential | D.P.M.
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Telephone | 941-753-9599
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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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