Provider Demographics
NPI:1093027815
Name:FLORIDA PODIATRY PA
Entity Type:Organization
Organization Name:FLORIDA PODIATRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:386-672-9797
Mailing Address - Street 1:335 CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3181
Mailing Address - Country:US
Mailing Address - Phone:386-672-9797
Mailing Address - Fax:386-615-0460
Practice Address - Street 1:335 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-3181
Practice Address - Country:US
Practice Address - Phone:386-672-9797
Practice Address - Fax:386-615-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty