Provider Demographics
NPI:1639235583
Name:CENTER FOR FOOT AND ANKLE DISORDERS, P.A.
Entity Type:Organization
Organization Name:CENTER FOR FOOT AND ANKLE DISORDERS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:RELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:941-907-2676
Mailing Address - Street 1:8340 LAKEWOOD RANCH BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5183
Mailing Address - Country:US
Mailing Address - Phone:941-907-2676
Mailing Address - Fax:941-907-2669
Practice Address - Street 1:8340 LAKEWOOD RANCH BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-5183
Practice Address - Country:US
Practice Address - Phone:941-907-2676
Practice Address - Fax:941-907-2669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2993213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO2993OtherFLORIDA LICENSE
FL340287800Medicaid
FLPO2993OtherFLORIDA LICENSE
FLK6323Medicare PIN
FL340287800Medicaid