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General NPI Number Information
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NPI Number | 1780750505
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Entity Type | Organization
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Legal Business Name | RICHARD NETTBOY DPM & MARTIN H SHANK DPM PA
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 09/15/2008
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Provider Practice Location Address
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Address Line | 23061 STATE RD 7
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City | BOCA RATON
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State | FL
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Zip | 33428-5433
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Country | US
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Telephone | 561-482-1900
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Fax | 561-482-1094
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Provider Business Mailing Address
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Address Line | 23061 STATE RD 7
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City | BOCA RATON
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State | FL
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Zip | 33428-5433
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Country | US
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Telephone | 561-482-1900
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Fax | 561-482-1094
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Authorized Official
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Title or Position | PARTNER
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Name | MARTIN H SHANK
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Credential | DPM
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Telephone | 561-482-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | P01387
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License Number State | FL
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