Provider Demographics
NPI:1073886685
Name:FEITZ FOOT CLINIC PA
Entity Type:Organization
Organization Name:FEITZ FOOT CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:FEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PODIATRY
Authorized Official - Phone:850-784-9787
Mailing Address - Street 1:2424 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2239
Mailing Address - Country:US
Mailing Address - Phone:850-784-9787
Mailing Address - Fax:850-784-9619
Practice Address - Street 1:3025 6TH ST
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-1930
Practice Address - Country:US
Practice Address - Phone:850-784-9787
Practice Address - Fax:850-784-9619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-2094213E00000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty