Provider Demographics
NPI:1548772767
Name:DANIEL FOOT & ANKLE, P.A.
Entity Type:Organization
Organization Name:DANIEL FOOT & ANKLE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDNTIALING
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAFUS
Authorized Official - Suffix:
Authorized Official - Credentials:CREDNETIALIST
Authorized Official - Phone:570-901-1957
Mailing Address - Street 1:542 W SAGAMORE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-3514
Mailing Address - Country:US
Mailing Address - Phone:863-301-3212
Mailing Address - Fax:
Practice Address - Street 1:542 W SAGAMORE AVE STE E
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3514
Practice Address - Country:US
Practice Address - Phone:305-333-3086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3939261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric