Provider Demographics
NPI:1306219597
Name:BAY BREEZE FOOT & ANKLE SPECIALISTS, PLLC
Entity type:Organization
Organization Name:BAY BREEZE FOOT & ANKLE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:AIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-734-5575
Mailing Address - Street 1:1022 MAIN ST
Mailing Address - Street 2:SUITE L
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-5238
Mailing Address - Country:US
Mailing Address - Phone:727-734-5575
Mailing Address - Fax:727-733-4147
Practice Address - Street 1:1022 MAIN ST
Practice Address - Street 2:SUITE L
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5238
Practice Address - Country:US
Practice Address - Phone:727-734-5575
Practice Address - Fax:727-733-4147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3681213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIM364AOtherMEDICARE PTAN
FL7466060001Medicare NSC
FLIM364AOtherMEDICARE PTAN