=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710702626
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. ARIC SWANCUTT DPM LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2024
-----------------------------------------------------
Last Update Date | 11/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5602 PGA BLVD STE 101
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33418-3829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-627-6444
-----------------------------------------------------
Fax | 561-627-3572
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 72 IRONWOOD WAY N
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33418-3717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-696-4042
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ARIC JAMES SWANCUTT
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 507-696-4042
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213EP1101X
-----------------------------------------------------
Taxonomy Name | Primary Podiatric Medicine Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------