MEDICARE: BOCA DEERFIELD FOOT CARE CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist	P03190	FL

General Provider Information

NPI Number	:	1306055371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOCA DEERFIELD FOOT CARE CENTER INC

Provider Business Mailing Address
First Line	:	3832 W HILLSBORO BLVD
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-9413
Country	:	US
Telephone Number	:	954-360-0400
Fax Number	:	954-360-9810

Provider Business Practice Location Address
First Line	:	3832 W HILLSBORO BLVD
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-9413
Country	:	US
Telephone Number	:	954-360-0400
Fax Number	:	954-360-9810

Authorized Official
Title or Position	:	OWNER
Name	:	ROSS MEL LIMON
Credential	:	D.P.M.
Telephone Number	:	954-360-0400

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	10/19/2008

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