Provider Demographics
NPI:1386668788
Name:NIETER, EDGAR H JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:H
Last Name:NIETER
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 E ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060
Mailing Address - Country:US
Mailing Address - Phone:954-941-1200
Mailing Address - Fax:954-942-4005
Practice Address - Street 1:1661 E ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060
Practice Address - Country:US
Practice Address - Phone:954-941-1200
Practice Address - Fax:954-942-4005
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP02132213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL480014334OtherRAILROAD MEDICARE
FL243967OtherAVMED
FL390191200Medicaid
FL65239OtherBLUE CROSS BLUE SHIELD
FL390191200Medicaid
FL65239ZMedicare PIN