Provider Demographics
NPI:1649664426
Name:ERIC S TRATHEN DPM INC
Entity type:Organization
Organization Name:ERIC S TRATHEN DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:TRATHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:239-689-1235
Mailing Address - Street 1:12630 WORLD PLAZA LN
Mailing Address - Street 2:70
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3987
Mailing Address - Country:US
Mailing Address - Phone:239-689-1235
Mailing Address - Fax:239-274-8319
Practice Address - Street 1:12630 WORLD PLAZA LN
Practice Address - Street 2:70
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3987
Practice Address - Country:US
Practice Address - Phone:239-689-1235
Practice Address - Fax:239-274-8319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3472213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty