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General NPI Number Information
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NPI Number | 1871003384
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Entity Type | Organization
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Legal Business Name | FPS FLORIDA PODIATRIC SERVICES, INC.
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Dates
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Enumeration Date | 10/10/2017
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Last Update Date | 01/29/2019
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Provider Practice Location Address
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Address Line | 4206 30TH LN E
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City | BRADENTON
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State | FL
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Zip | 34208-7383
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Country | US
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Telephone | 941-567-4944
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Fax | 941-567-4944
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Provider Business Mailing Address
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Address Line | PO BOX 20536
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City | BRADENTON
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State | FL
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Zip | 34204-0536
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Country | US
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Telephone | 941-567-4944
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Fax | 941-567-4944
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Authorized Official
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Title or Position | OWNER
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Name | MELVIN BERNARD PRICE
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Credential | DPM
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Telephone | 941-567-4944
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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 | PO2875
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License Number State | FL
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