Provider Demographics
NPI: | 1407234719 |
---|---|
Name: | JPFO LLC |
Entity Type: | Organization |
Organization Name: | JPFO LLC |
Other - Org Name: | FUTCH PODIATRY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JEFFERSON |
Authorized Official - Middle Name: | PEARCE |
Authorized Official - Last Name: | FUTCH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DPM |
Authorized Official - Phone: | 229-834-5480 |
Mailing Address - Street 1: | 145 HILDEN RD |
Mailing Address - Street 2: | SUITE 103 |
Mailing Address - City: | PONTE VEDRA |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32081-8401 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 145 HILDEN RD |
Practice Address - Street 2: | SUITE 103 |
Practice Address - City: | PONTE VEDRA |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32081-8401 |
Practice Address - Country: | US |
Practice Address - Phone: | 229-834-5480 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-05-07 |
Last Update Date: | 2015-05-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | PO3392 | 213E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Single Specialty |