Provider Demographics
NPI:1689010837
Name:DALE R MONAST DPM PLLC
Entity Type:Organization
Organization Name:DALE R MONAST DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MONAST
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-586-3668
Mailing Address - Street 1:1680 W BAY DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3002
Mailing Address - Country:US
Mailing Address - Phone:727-586-3668
Mailing Address - Fax:727-588-0490
Practice Address - Street 1:1680 W BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3002
Practice Address - Country:US
Practice Address - Phone:727-586-3668
Practice Address - Fax:727-588-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1709213E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDU9882Medicare PIN
FL0931040001Medicare NSC