Provider Demographics
NPI:1992779920
Name:MAGUIRE, EDMUND CORRY (DPM)
Entity type:Individual
Prefix:
First Name:EDMUND
Middle Name:CORRY
Last Name:MAGUIRE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:E
Other - Middle Name:CORRY
Other - Last Name:MAGUIRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:3165 MCCRORY PL
Mailing Address - Street 2:STE 174
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3727
Mailing Address - Country:US
Mailing Address - Phone:407-423-1234
Mailing Address - Fax:407-517-1040
Practice Address - Street 1:1261 BLACKWOOD AVE
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4521
Practice Address - Country:US
Practice Address - Phone:407-877-2900
Practice Address - Fax:407-877-0193
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2783213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00126099OtherR/R MEDICARE
FL390477600Medicaid
FL46489ZMedicare PIN
FLP00126099OtherR/R MEDICARE