Provider Demographics
NPI:1710351648
Name:THE BAREFOOT PHYSICIAN, PLLC
Entity Type:Organization
Organization Name:THE BAREFOOT PHYSICIAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, AP, MSOM, LAC
Authorized Official - Phone:727-543-7039
Mailing Address - Street 1:1926 HOLLYWOOD BLVD
Mailing Address - Street 2:202
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4532
Mailing Address - Country:US
Mailing Address - Phone:561-510-6967
Mailing Address - Fax:
Practice Address - Street 1:1926 HOLLYWOOD BLVD
Practice Address - Street 2:202
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4532
Practice Address - Country:US
Practice Address - Phone:561-510-6967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3669261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center