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General NPI Number Information
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NPI Number | 1801299870
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Entity Type | Organization
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Legal Business Name | PATRIOT PODIATRY PLLC
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Dates
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Enumeration Date | 10/03/2014
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 2760 SE 17TH ST STE 102
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City | OCALA
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State | FL
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Zip | 34471-5550
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Country | US
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Telephone | 352-351-1555
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Fax | 352-351-1330
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Provider Business Mailing Address
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Address Line | 2760 SE 17TH ST STE 102
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City | OCALA
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State | FL
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Zip | 34471-5550
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Country | US
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Telephone | 954-854-5688
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | STEPHANIE FREY
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Credential | D.P.M.
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Telephone | 352-208-1140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3605
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3604
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License Number State | FL
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