Provider Demographics
NPI:1679751549
Name:DR. JOHN J. ADLER PA
Entity Type:Organization
Organization Name:DR. JOHN J. ADLER PA
Other - Org Name:FOOT & ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:239-573-9200
Mailing Address - Street 1:1722 DEL PRADO BLVD S
Mailing Address - Street 2:SUITE 12
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-5525
Mailing Address - Country:US
Mailing Address - Phone:239-573-9200
Mailing Address - Fax:855-376-5040
Practice Address - Street 1:1722 DEL PRADO BLVD S
Practice Address - Street 2:SUITE 12
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-5525
Practice Address - Country:US
Practice Address - Phone:239-573-9200
Practice Address - Fax:855-376-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2068213ES0103X
FLPO2995213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
65161OtherPROVIDER BLUE CROSS
65161ZOtherMEDICARE GROUP
FL1306802921OtherNPI
FL0931100001Medicare NSC
65161ZOtherMEDICARE GROUP
CL4734Medicare PIN
FLK3844Medicare PIN
65161OtherPROVIDER BLUE CROSS
FLE8188ZMedicare UPIN