Provider Demographics
NPI:1912381708
Name:FLORIDA FOOT & ANKLE CARE, LLC
Entity Type:Organization
Organization Name:FLORIDA FOOT & ANKLE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SELBST
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-638-8635
Mailing Address - Street 1:5175 W ATLANTIC AVE
Mailing Address - Street 2:STE F
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8101
Mailing Address - Country:US
Mailing Address - Phone:561-638-8635
Mailing Address - Fax:561-638-8632
Practice Address - Street 1:5175 W ATLANTIC AVE
Practice Address - Street 2:STE F
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8101
Practice Address - Country:US
Practice Address - Phone:561-638-8635
Practice Address - Fax:561-638-8632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3651213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty