MEDICARE: ATLANTIC PODIATRY ASSOCIATES DPM PA

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	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1477174050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC PODIATRY ASSOCIATES DPM PA

Provider Business Mailing Address
First Line	:	1890 LPGA BLVD STE 230
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-7131
Country	:	US
Telephone Number	:	386-274-3336
Fax Number	:	386-274-3660

Provider Business Practice Location Address
First Line	:	595 W GRANADA BLVD STE F
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5182
Country	:	US
Telephone Number	:	386-673-2266
Fax Number	:	386-676-2772

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	JAMES W RUST
Credential	:
Telephone Number	:	386-274-3336

Provider Enumeration Date	:	05/05/2020
Last Update Date	:	05/05/2020

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Directions to “ATLANTIC PODIATRY ASSOCIATES DPM PA ” Practice Location

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