Provider Demographics
NPI:1447616495
Name:FLORIDA ORTHOPEDIC FOOT & ANKLE CENTER LLC
Entity Type:Organization
Organization Name:FLORIDA ORTHOPEDIC FOOT & ANKLE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:COTTOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-924-8777
Mailing Address - Street 1:1630 S TUTTLE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3108
Mailing Address - Country:US
Mailing Address - Phone:941-924-8777
Mailing Address - Fax:
Practice Address - Street 1:1630 S TUTTLE AVE STE A
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3108
Practice Address - Country:US
Practice Address - Phone:941-924-8777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3305213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty