Provider Demographics
NPI:1811177199
Name:NORTH FLORIDA FOOT AND ANKLE ASSOCIATES PC
Entity type:Organization
Organization Name:NORTH FLORIDA FOOT AND ANKLE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHYATT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-331-7543
Mailing Address - Street 1:6717 N.W. 11TH PLACE
Mailing Address - Street 2:SUITE D
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605
Mailing Address - Country:US
Mailing Address - Phone:352-331-7543
Mailing Address - Fax:352-331-7756
Practice Address - Street 1:6717 N.W. 11TH PLACE
Practice Address - Street 2:SUITE D
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605
Practice Address - Country:US
Practice Address - Phone:352-331-7543
Practice Address - Fax:352-331-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1605213E00000X
FLPO2753213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65590OtherBCBS
FL390448200Medicaid
FLU39847Medicare UPIN
FLK0514Medicare PIN
FL390448200Medicaid
FLE1171ZMedicare PIN