Provider Demographics
NPI:1477814176
Name:ADLER PODIATRY CLINIC PLLC
Entity Type:Organization
Organization Name:ADLER PODIATRY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:F
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:904-731-1711
Mailing Address - Street 1:3636 UNIVERSITY BLVD S
Mailing Address - Street 2:BLDG C
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4250
Mailing Address - Country:US
Mailing Address - Phone:904-731-1711
Mailing Address - Fax:904-731-9270
Practice Address - Street 1:320 1ST ST N
Practice Address - Street 2:SUITE 709
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-6944
Practice Address - Country:US
Practice Address - Phone:904-731-1711
Practice Address - Fax:904-731-9270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO690213ES0103X
FLPO3414213ES0103X
FLPO2158213ES0103X
FLPO3516213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty