MEDICARE: DR JESSICA TAUB PODIATRY DPM LLC

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	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1841032836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR JESSICA TAUB PODIATRY DPM LLC

Provider Business Mailing Address
First Line	:	3515 SE WILLOUGHBY BLVD
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-5059
Country	:	US
Telephone Number	:	772-283-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1331 SE PORT ST LUCIE BLVD STE 101
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5331
Country	:	US
Telephone Number	:	772-283-3800
Fax Number	:

Authorized Official
Title or Position	:	AOUTORIZED OFFICIAL
Name	:	JESSICA EMILY TAUB
Credential	:	DPM
Telephone Number	:	216-402-3827

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	06/10/2024

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