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	:	1902427586
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	:	21 HOSPITAL DR STE 170A
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-2454
Country	:	US
Telephone Number	:	386-586-7373
Fax Number	:	386-586-7346

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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