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General NPI Number Information
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NPI Number | 1700015849
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Entity Type | Organization
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Legal Business Name | CORY HAIMON DPM PA
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Dates
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Enumeration Date | 07/10/2009
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Last Update Date | 04/19/2012
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Provider Practice Location Address
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Address Line | 941 SE 1ST ST SUITE B
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City | BELLE GLADE
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State | FL
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Zip | 33430-4353
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Country | US
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Telephone | 561-993-3668
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Fax | 561-993-3668
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Provider Business Mailing Address
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Address Line | 7431 W ATLANTIC AVE STE 33
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City | DELRAY BEACH
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State | FL
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Zip | 33446-3505
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Country | US
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Telephone | 561-496-6900
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Fax | 561-496-5348
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. IRA J JACOBSON
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Credential | DPM
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Telephone | 561-993-3668
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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 | PO0001592
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO0001689
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License Number State | FL
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