Provider Demographics
NPI:1558918813
Name:DESIREE GARZON, DPM, PA
Entity Type:Organization
Organization Name:DESIREE GARZON, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:OLGA
Authorized Official - Last Name:GARZON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-673-0897
Mailing Address - Street 1:1325 S CONGRESS AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-5802
Mailing Address - Country:US
Mailing Address - Phone:541-734-3960
Mailing Address - Fax:561-734-2811
Practice Address - Street 1:1325 S CONGRESS AVE STE 108
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-5802
Practice Address - Country:US
Practice Address - Phone:561-734-3960
Practice Address - Fax:561-734-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013076100Medicaid
MJ76EOtherBLUE CROSS BLUE SHEILD