Provider Demographics
NPI:1366630030
Name:D'ERRICO, ALBERT ANDREW (DPM)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:ANDREW
Last Name:D'ERRICO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13600 ICOT BLVD
Mailing Address - Street 2:BLDG A
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3703
Mailing Address - Country:US
Mailing Address - Phone:888-290-6321
Mailing Address - Fax:888-875-1592
Practice Address - Street 1:13600 ICOT BLVD
Practice Address - Street 2:BLDG A
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3703
Practice Address - Country:US
Practice Address - Phone:888-290-6321
Practice Address - Fax:888-875-1592
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO2649213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU73607Medicare UPIN
FLE1962BMedicare PIN