Provider Demographics
NPI:1083884936
Name:ANKLE & FOOT CENTER OF TAMPA BAY
Entity Type:Organization
Organization Name:ANKLE & FOOT CENTER OF TAMPA BAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:CREIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:813-254-4747
Mailing Address - Street 1:2835 W DE LEON ST
Mailing Address - Street 2:SUITE #101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4130
Mailing Address - Country:US
Mailing Address - Phone:813-254-4747
Mailing Address - Fax:813-254-3634
Practice Address - Street 1:1408 W REYNOLDS ST
Practice Address - Street 2:SUITE A
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4361
Practice Address - Country:US
Practice Address - Phone:813-754-9876
Practice Address - Fax:813-759-9387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4206260005Medicare NSC