Provider Demographics
NPI:1528363801
Name:GS FAMILY FOOT CARE PA
Entity Type:Organization
Organization Name:GS FAMILY FOOT CARE PA
Other - Org Name:GS FAMILY FOOT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRANT-SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-464-0102
Mailing Address - Street 1:5467 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2954
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5467 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-2954
Practice Address - Country:US
Practice Address - Phone:954-464-0102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3361213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty