Provider Demographics
NPI:1689656019
Name:DENAULT, ALBERT C II (DPM)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:C
Last Name:DENAULT
Suffix:II
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 MANATEE AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1933
Mailing Address - Country:US
Mailing Address - Phone:941-749-0626
Mailing Address - Fax:941-749-0618
Practice Address - Street 1:311 MANATEE AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208
Practice Address - Country:US
Practice Address - Phone:941-749-0626
Practice Address - Fax:941-749-0618
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2367213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390163700Medicaid
U47242Medicare UPIN
FL480028294Medicare PIN
65324Medicare PIN
FLP00175536Medicare PIN