Provider Demographics
NPI:1073535787
Name:DEMNER, MICHAEL GARY (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GARY
Last Name:DEMNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8787 BRYAN DAIRY RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1251
Mailing Address - Country:US
Mailing Address - Phone:727-391-1913
Mailing Address - Fax:727-319-2713
Practice Address - Street 1:8787 BRYAN DAIRY RD
Practice Address - Street 2:SUITE 350
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1251
Practice Address - Country:US
Practice Address - Phone:727-391-1913
Practice Address - Fax:727-319-2713
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP01338213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
87709OtherBCBS
FLK3165Medicare ID - Type Unspecified
T55512Medicare UPIN