Provider Demographics
NPI:1184252512
Name:SWANCUTT, ARIC J
Entity type:Individual
Prefix:
First Name:ARIC
Middle Name:J
Last Name:SWANCUTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 IRONWOOD WAY N
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-3717
Mailing Address - Country:US
Mailing Address - Phone:507-696-4042
Mailing Address - Fax:
Practice Address - Street 1:5602 PGA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-3829
Practice Address - Country:US
Practice Address - Phone:561-627-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4489213EP1101X
FLPO4489213EP0504X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine