Provider Demographics
NPI:1457529976
Name:EARL HOROWITZ DPM PA
Entity Type:Organization
Organization Name:EARL HOROWITZ DPM PA
Other - Org Name:EARL R HOROWITZ DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOROWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:904-387-0433
Mailing Address - Street 1:2236 PARK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4316
Mailing Address - Country:US
Mailing Address - Phone:904-387-0433
Mailing Address - Fax:904-387-3668
Practice Address - Street 1:2236 PARK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4316
Practice Address - Country:US
Practice Address - Phone:904-387-0433
Practice Address - Fax:904-387-3668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0000298213E00000X
FLPO298213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041210400Medicaid
FL1427050194OtherNPI INDIVIDUAL
FLBPU9TOtherBCBS FL
FL041210400Medicaid
7188550001Medicare NSC
FLIR466AMedicare PIN