Provider Demographics
NPI:1063555993
Name:MARTIN SHANK DPM PA & RICHARD NETTBOY DPM
Entity type:Organization
Organization Name:MARTIN SHANK DPM PA & RICHARD NETTBOY DPM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHANK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-482-1900
Mailing Address - Street 1:23061 STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-5433
Mailing Address - Country:US
Mailing Address - Phone:561-482-1900
Mailing Address - Fax:561-482-1094
Practice Address - Street 1:23061 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-5433
Practice Address - Country:US
Practice Address - Phone:561-482-1900
Practice Address - Fax:561-482-1094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP02707213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U71304Medicare UPIN
FLE0998Medicare ID - Type Unspecified