Provider Demographics
NPI:1437337649
Name:ALBERT C DENAULT II DPM
Entity Type:Organization
Organization Name:ALBERT C DENAULT II DPM
Other - Org Name:FAMILY FOOTCARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:DENAULT
Authorized Official - Suffix:II
Authorized Official - Credentials:DPM
Authorized Official - Phone:941-749-0626
Mailing Address - Street 1:311 MANATEE AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1933
Mailing Address - Country:US
Mailing Address - Phone:941-749-0626
Mailing Address - Fax:941-749-0618
Practice Address - Street 1:311 MANATEE AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1933
Practice Address - Country:US
Practice Address - Phone:941-749-0626
Practice Address - Fax:941-749-0618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2367213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1100520001Medicare NSC