Provider Demographics
NPI:1306055371
Name:BOCA DEERFIELD FOOT CARE CENTER INC
Entity type:Organization
Organization Name:BOCA DEERFIELD FOOT CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:MEL
Authorized Official - Last Name:LIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-360-0400
Mailing Address - Street 1:3832 W HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9413
Mailing Address - Country:US
Mailing Address - Phone:954-360-0400
Mailing Address - Fax:954-360-9810
Practice Address - Street 1:3832 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9413
Practice Address - Country:US
Practice Address - Phone:954-360-0400
Practice Address - Fax:954-360-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP03190213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65922ZMedicare PIN
FLV08983Medicare UPIN
FL5294340001Medicare NSC