| NPI | 1326250010 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLEY M LUNDEEN Office Manager 904-551-1765 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO1898) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO1898) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO1898) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: FL PO1898) | |
| 213EP0504X Podiatrist, Public Medicine (Licence: FL PO1898) | |
| 213ER0200X Podiatrist, Radiology (Licence: FL PO1898) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2011-07-08 |