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General NPI Number Information
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NPI Number | 1568491421
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Entity Type | Organization
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Legal Business Name | HEALTH PARK FOOT & ANKLE ASSOCIATES INC
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 01/26/2010
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Provider Practice Location Address
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Address Line | 1975 OLD MOULTRIE RD
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5164
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Country | US
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Telephone | 904-825-0046
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Fax | 904-826-1586
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Provider Business Mailing Address
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Address Line | 1975 OLD MOULTRIE RD
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5164
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Country | US
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Telephone | 904-825-0046
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Fax | 904-826-1586
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Authorized Official
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Title or Position | OWNER
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Name | MR. ED W MALLARD
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Credential |
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Telephone | 904-825-0046
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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 |
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License Number State | FL
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