Provider Demographics
NPI:1457510398
Name:ADVANCED PODIATRY, PA
Entity Type:Organization
Organization Name:ADVANCED PODIATRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:813-971-4678
Mailing Address - Street 1:13801 BRUCE B DOWNS BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3937
Mailing Address - Country:US
Mailing Address - Phone:813-971-4678
Mailing Address - Fax:813-482-0036
Practice Address - Street 1:17222 HOSPITAL BLVD
Practice Address - Street 2:SUITE 218
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-8925
Practice Address - Country:US
Practice Address - Phone:352-796-7800
Practice Address - Fax:352-796-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2520213ES0131X
213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1982756706OtherGROUP NPI
FL1982756706OtherORGANIZATION FOR OTHER LOCATION
FLM2469OtherMEDICARE GROUP PTAN
FLM2475OtherMEDICARE GROUP PTAN