Provider Demographics
NPI:1811900392
Name:CORY HAIMON DPM PA
Entity type:Organization
Organization Name:CORY HAIMON DPM PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:HAIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-289-5950
Mailing Address - Street 1:1605 S US HIGHWAY 1
Mailing Address - Street 2:SEARISE 201D
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-8436
Mailing Address - Country:US
Mailing Address - Phone:561-289-5950
Mailing Address - Fax:561-747-6752
Practice Address - Street 1:941 SE 1ST ST
Practice Address - Street 2:STE B
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-4353
Practice Address - Country:US
Practice Address - Phone:561-993-3668
Practice Address - Fax:561-747-6752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390417200Medicaid
72837CMedicare PIN
FL4623420001Medicare NSC
FL390417200Medicaid
FLT88572Medicare UPIN
FL4623420002Medicare NSC
FL72837Medicare ID - Type Unspecified