Provider Demographics
NPI:1265658546
Name:GULF COAST PODIATRY OF NORTHWEST FLORIDA PA
Entity Type:Organization
Organization Name:GULF COAST PODIATRY OF NORTHWEST FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:KIEFER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:850-434-9867
Mailing Address - Street 1:1851 N 9TH AVE.
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-4535
Mailing Address - Country:US
Mailing Address - Phone:850-434-9867
Mailing Address - Fax:850-434-9878
Practice Address - Street 1:1851 N 9TH AVE.
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-4535
Practice Address - Country:US
Practice Address - Phone:850-434-9867
Practice Address - Fax:850-434-9878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1874213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65020OtherBLUE CROSS BLUE SHIELD
FL=========OtherTAX ID
FL=========OtherTAX ID
FLT94329Medicare UPIN
FL480007421Medicare PIN
FLK1790Medicare PIN