Provider Demographics
NPI:1417132952
Name:ODRO, FAZEKAS & WERD PA
Entity Type:Organization
Organization Name:ODRO, FAZEKAS & WERD PA
Other - Org Name:FOOT AND ANKLE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAZEKAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:863-687-3404
Mailing Address - Street 1:2939 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-4046
Mailing Address - Country:US
Mailing Address - Phone:863-687-3404
Mailing Address - Fax:863-687-4672
Practice Address - Street 1:2939 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4046
Practice Address - Country:US
Practice Address - Phone:863-687-3404
Practice Address - Fax:863-687-4672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0000788213E00000X
FLPO0001370213E00000X
FLPO000248213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCA4648Medicare PIN
FL0596860002Medicare NSC