Provider Demographics
NPI:1528483476
Name:FLORIDA REGIONAL FOOT AND ANKLE SPECIALISTS PLLC
Entity type:Organization
Organization Name:FLORIDA REGIONAL FOOT AND ANKLE SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NGOC HAN
Authorized Official - Middle Name:THI
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-586-8502
Mailing Address - Street 1:20461 S TAMIAMI TRL STE 18
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-8103
Mailing Address - Country:US
Mailing Address - Phone:305-586-8502
Mailing Address - Fax:239-323-9933
Practice Address - Street 1:20461 S TAMIAMI TRL STE 18
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-8103
Practice Address - Country:US
Practice Address - Phone:305-586-8502
Practice Address - Fax:239-323-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-02
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213E00000X
FLPO3630261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty