Provider Demographics
NPI:1699711176
Name:BAY PODIATRY CENTER, PA
Entity type:Organization
Organization Name:BAY PODIATRY CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:E
Authorized Official - Last Name:GAITHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:850-763-7244
Mailing Address - Street 1:2430 JENKS AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4304
Mailing Address - Country:US
Mailing Address - Phone:850-763-7244
Mailing Address - Fax:850-763-0157
Practice Address - Street 1:2430 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4304
Practice Address - Country:US
Practice Address - Phone:850-763-7244
Practice Address - Fax:850-763-0157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5741AMedicare ID - Type Unspecified