Provider Demographics
NPI:1982934626
Name:CORY B HAIMON, D.P.M., PA
Entity Type:Organization
Organization Name:CORY B HAIMON, D.P.M., PA
Other - Org Name:GOLD COAST PODIATRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-496-6900
Mailing Address - Street 1:7431 W ATLANTIC AVE STE 33
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3505
Mailing Address - Country:US
Mailing Address - Phone:561-496-6900
Mailing Address - Fax:561-496-5348
Practice Address - Street 1:170 S BARFIELD HWY
Practice Address - Street 2:SUITE 106
Practice Address - City:PAHOKEE
Practice Address - State:FL
Practice Address - Zip Code:33476-1868
Practice Address - Country:US
Practice Address - Phone:561-692-9024
Practice Address - Fax:561-496-5348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0001592213E00000X
FLPO0001689213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390417200Medicaid
FL390417200Medicaid