=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598829475
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR EDGAR H NIETER PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2006
-----------------------------------------------------
Last Update Date | 03/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1661 E ATLANTIC BLVD
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33060-6750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-941-1200
-----------------------------------------------------
Fax | 954-942-4005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1661 E ATLANTIC BLVD
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33060-6750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-941-1200
-----------------------------------------------------
Fax | 954-942-4005
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. EDGAR H. NIETER
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 954-941-1200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | PO2132
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------