| NPI | 1598127151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANDRA K GORDON Owner/CEO 904-666-5170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3624) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: FL PO3308) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2016-11-17 |