Provider Demographics
NPI:1477810281
Name:CORY HAIMON, DPM PA
Entity Type:Organization
Organization Name:CORY HAIMON, DPM PA
Other - Org Name:GOLD COAST PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-496-6900
Mailing Address - Street 1:7431 W ATLANTIC AVE
Mailing Address - Street 2:STE 33
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1054 GATEWAY BLVD
Practice Address - Street 2:STE 110
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8301
Practice Address - Country:US
Practice Address - Phone:561-496-6900
Practice Address - Fax:561-496-5348
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORY HAIMON, DPM PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-18
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1592213E00000X
FLPO1689213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3904172Medicaid
FL72837Medicare PIN