=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629349840
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAPLES FOOT DOCTOR, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2012
-----------------------------------------------------
Last Update Date | 01/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5490 BRYSON DR SUITE 201
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34109-0924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-325-8717
-----------------------------------------------------
Fax | 866-214-2666
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5490 BRYSON DR SUITE 201
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34109-0924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-325-8717
-----------------------------------------------------
Fax | 866-214-2666
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. ELIOT SHERR
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 978-531-4484
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP1100X
-----------------------------------------------------
Taxonomy Name | Podiatric Clinic/Center
-----------------------------------------------------
License Number | PO3399
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------