Provider Demographics
NPI:1326058249
Name:GENTLE FOOT CARE CLINIC, PA
Entity Type:Organization
Organization Name:GENTLE FOOT CARE CLINIC, PA
Other - Org Name:GENTLE FOOT CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAIRO
Authorized Official - Middle Name:B
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:813-782-3233
Mailing Address - Street 1:38192 MEDICAL CENTER AVE.
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540
Mailing Address - Country:US
Mailing Address - Phone:813-782-3233
Mailing Address - Fax:813-782-5332
Practice Address - Street 1:38192 MEDICAL CENTER AVE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-1380
Practice Address - Country:US
Practice Address - Phone:813-782-3233
Practice Address - Fax:813-502-5904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLO0PH6OtherBCBS
FL114053400Medicaid
FLK5490OtherMEDICARE GROUP
FLDB7111OtherRR MCARE
OHK5490Medicare PIN
FL340241003Medicaid