Provider Demographics
NPI:1265419964
Name:ANKLE & FOOT CENTER OF TAMPA BAY
Entity type:Organization
Organization Name:ANKLE & FOOT CENTER OF TAMPA BAY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:CREIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:813-254-4747
Mailing Address - Street 1:2835 W DE LEON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4168
Mailing Address - Country:US
Mailing Address - Phone:813-254-6592
Mailing Address - Fax:813-254-3634
Practice Address - Street 1:2835 W DE LEON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4168
Practice Address - Country:US
Practice Address - Phone:813-254-6592
Practice Address - Fax:813-254-3634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97860OtherBCBS
FL4206260001Medicare NSC
FL4206260004Medicare NSC
FL4206260006Medicare NSC
FL4206260009Medicare NSC
FL4206260002Medicare NSC
FL97860Medicare ID - Type Unspecified
FL4206260008Medicare NSC
FL4206260003Medicare NSC
FL97860OtherBCBS
FL4206260005Medicare NSC
FL4206260010Medicare NSC
FL4206260007Medicare NSC
FLCBO477Medicare PIN