MEDICARE: GS FAMILY FOOT CARE 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	PO 3361	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528363801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GS FAMILY FOOT CARE PA

Provider Business Mailing Address
First Line	:	5467 N STATE ROAD 7
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33319-2954
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5467 N STATE ROAD 7
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33319-2954
Country	:	US
Telephone Number	:	954-464-0102
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CRISTAL S GRANT-SPENCE
Credential	:	DPM
Telephone Number	:	954-464-0102

Provider Enumeration Date	:	01/19/2011
Last Update Date	:	01/19/2011

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Directions to “GS FAMILY FOOT CARE PA ” Practice Location

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