Provider Demographics
NPI:1902968860
Name:BOCA PODIATRY GROUP, P.A.
Entity Type:Organization
Organization Name:BOCA PODIATRY GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SOMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-750-3060
Mailing Address - Street 1:1353 W PALMETTO PARK RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-3303
Mailing Address - Country:US
Mailing Address - Phone:561-750-3060
Mailing Address - Fax:561-750-3011
Practice Address - Street 1:1353 W PALMETTO PARK RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-3303
Practice Address - Country:US
Practice Address - Phone:561-750-3060
Practice Address - Fax:561-750-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2245213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390091600Medicaid
FLT51378Medicare UPIN
FL65281Medicare ID - Type Unspecified
0779220001Medicare NSC