Provider Demographics
NPI:1154349082
Name:ATLANTIC PODIATRY ASSOCIATES DPM PA
Entity type:Organization
Organization Name:ATLANTIC PODIATRY ASSOCIATES DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:RUST
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:386-274-3336
Mailing Address - Street 1:1890 LPGA BLVD
Mailing Address - Street 2:STE 230
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-7131
Mailing Address - Country:US
Mailing Address - Phone:386-274-3336
Mailing Address - Fax:386-274-3660
Practice Address - Street 1:1890 LPGA BLVD
Practice Address - Street 2:STE 230
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-7131
Practice Address - Country:US
Practice Address - Phone:386-274-3336
Practice Address - Fax:386-274-3660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40973Medicare PIN
FL4380280001Medicare NSC