Provider Demographics
NPI:1285957654
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:MR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
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 1:126 CENTER ST STE B3
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4363
Practice Address - Country:US
Practice Address - Phone:561-496-6900
Practice Address - Fax:561-496-4358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0001689213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72837CMedicare PIN