Provider Demographics
NPI:1336303353
Name:PODIATRY NETWORK OF FLORIDA
Entity Type:Organization
Organization Name:PODIATRY NETWORK OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:LABOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:813-250-0616
Mailing Address - Street 1:1408 W REYNOLDS ST STE A
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-4361
Mailing Address - Country:US
Mailing Address - Phone:813-250-0616
Mailing Address - Fax:813-642-3098
Practice Address - Street 1:1408 W REYNOLDS ST STE A
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4361
Practice Address - Country:US
Practice Address - Phone:813-250-0616
Practice Address - Fax:813-642-3098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1092302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization