Provider Demographics
NPI:1013038272
Name:IMPERIAL POINT PODIATRY ASSOC INC
Entity Type:Organization
Organization Name:IMPERIAL POINT PODIATRY ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-771-5900
Mailing Address - Street 1:6405 N FEDERAL HWY
Mailing Address - Street 2:SUITE 405
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:954-771-5900
Mailing Address - Fax:954-771-5959
Practice Address - Street 1:6405 N FEDERAL HWY
Practice Address - Street 2:SUITE 405
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1412
Practice Address - Country:US
Practice Address - Phone:954-771-5900
Practice Address - Fax:954-771-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4736840001Medicare NSC