Provider Demographics
NPI:1033306824
Name:ROBERT F HERBOLD,JR.,DPM,PA
Entity Type:Organization
Organization Name:ROBERT F HERBOLD,JR.,DPM,PA
Other - Org Name:ACCREDITED PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:HERBOLD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:941-929-1234
Mailing Address - Street 1:4717 SWIFT RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-6433
Mailing Address - Country:US
Mailing Address - Phone:941-929-1234
Mailing Address - Fax:941-929-3668
Practice Address - Street 1:4717 SWIFT RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6433
Practice Address - Country:US
Practice Address - Phone:941-929-1234
Practice Address - Fax:941-929-3668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0002764213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1293250001Medicare NSC
FLK6003Medicare PIN