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General NPI Number Information
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NPI Number | 1932282167
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Entity Type | Organization
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Legal Business Name | LIVE OAK FOOT & ANKLE
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 07/31/2020
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Provider Practice Location Address
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Address Line | 17820 SE 109TH AVE STE 102
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City | SUMMERFIELD
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State | FL
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Zip | 34491
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Country | US
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Telephone | 352-347-3338
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Fax | 352-347-3389
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Provider Business Mailing Address
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Address Line | 17820 SE 109TH AVE STE 102
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City | SUMMERFIELD
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State | FL
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Zip | 34491
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Country | US
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Telephone | 352-347-3338
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Fax | 352-347-3389
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Authorized Official
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Title or Position | MEMBER
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Name | DR. STEVEN C EFFREN
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Credential | DPM
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Telephone | 352-347-3338
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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 |
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License Number State |
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