Provider Demographics
NPI:1073199816
Name:VOLUSIA COUNTY PODIATRY INC
Entity Type:Organization
Organization Name:VOLUSIA COUNTY PODIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFUS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:386-777-3266
Mailing Address - Street 1:PO BOX 530730
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32753-0730
Mailing Address - Country:US
Mailing Address - Phone:386-777-3266
Mailing Address - Fax:386-774-9096
Practice Address - Street 1:691 HANGNEST LN
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-7658
Practice Address - Country:US
Practice Address - Phone:386-777-3266
Practice Address - Fax:386-774-9096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty