| NPI | 1194156158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICKEY EDSON GORDON Owner 239-566-8800 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO0002638) |
| Enumeration Date | 2013-12-02 |
| Last Update Date | 2013-12-02 |