Provider Demographics
NPI:1093266991
Name:FLORIDA FOOT AND ANKLE SPECIALISTS PA
Entity Type:Organization
Organization Name:FLORIDA FOOT AND ANKLE SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRIST
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:239-272-1185
Mailing Address - Street 1:1130 CREEKSIDE PKWY
Mailing Address - Street 2:#111324
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-1100
Mailing Address - Country:US
Mailing Address - Phone:239-272-1185
Mailing Address - Fax:239-431-7942
Practice Address - Street 1:700 2ND AVE N
Practice Address - Street 2:SUITE 204
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5756
Practice Address - Country:US
Practice Address - Phone:239-272-1185
Practice Address - Fax:239-431-7942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1768213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty