Provider Demographics
NPI:1932282167
Name:LIVE OAK FOOT & ANKLE
Entity Type:Organization
Organization Name:LIVE OAK FOOT & ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:EFFREN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-347-3338
Mailing Address - Street 1:17820 SE 109TH AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491
Mailing Address - Country:US
Mailing Address - Phone:352-347-3338
Mailing Address - Fax:352-347-3389
Practice Address - Street 1:17820 SE 109TH AVE
Practice Address - Street 2:STE 102
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491
Practice Address - Country:US
Practice Address - Phone:352-347-3338
Practice Address - Fax:352-347-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40452Medicare PIN
FL6525430001Medicare NSC
FL1119950001Medicare NSC