Provider Demographics
NPI:1659879195
Name:GOLD FOOT AND ANKLE LLC
Entity Type:Organization
Organization Name:GOLD FOOT AND ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OULDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-530-7585
Mailing Address - Street 1:3163 INTEGRA LAKES LN APT 119
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-3891
Mailing Address - Country:US
Mailing Address - Phone:407-508-6456
Mailing Address - Fax:
Practice Address - Street 1:1000 BELCHER RD S STE 4
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3307
Practice Address - Country:US
Practice Address - Phone:727-530-7585
Practice Address - Fax:727-536-1831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty