Provider Demographics
NPI:1124536529
Name:SOUTH FLORIDA ADVANCED ANKLE & FOOT SURGEONS
Entity type:Organization
Organization Name:SOUTH FLORIDA ADVANCED ANKLE & FOOT SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALPHONSE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIBUIANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-564-7270
Mailing Address - Street 1:835 TAMMY RD
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-8410
Mailing Address - Country:US
Mailing Address - Phone:239-564-7270
Mailing Address - Fax:
Practice Address - Street 1:835 TAMMY RD
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-8410
Practice Address - Country:US
Practice Address - Phone:239-564-7270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0002858213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty