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General NPI Number Information
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NPI Number | 1942390182
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Entity Type | Organization
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Legal Business Name | INDIAN RIVER FOOT & ANKLE, PA
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 1424 US HIGHWAY 1 SUITE A
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City | SEBASTIAN
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State | FL
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Zip | 32958-1619
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Country | US
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Telephone | 772-589-3110
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Fax | 772-388-1929
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Provider Business Mailing Address
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Address Line | 1424 US HIGHWAY 1 SUITE A
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City | SEBASTIAN
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State | FL
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Zip | 32958-1619
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Country | US
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Telephone | 772-589-3110
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Fax | 772-388-1929
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID J HAILE
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Credential | DPM
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Telephone | 772-589-3110
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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 |
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License Number State |
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