Provider Demographics
NPI:1245538735
Name:AMERICAN FOOT & ANKLE CLINIC OF TAMPA BAY, INC.
Entity type:Organization
Organization Name:AMERICAN FOOT & ANKLE CLINIC OF TAMPA BAY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:A
Authorized Official - Last Name:DONATE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:813-380-8346
Mailing Address - Street 1:5322 PRIMROSE LAKE CIR STE F
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3659
Mailing Address - Country:US
Mailing Address - Phone:813-380-8346
Mailing Address - Fax:813-354-4635
Practice Address - Street 1:16350 BRUCE B. DOWNS BLVD, UNIT 46879
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647
Practice Address - Country:US
Practice Address - Phone:813-380-8346
Practice Address - Fax:813-388-4180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2970213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FF599AOtherMEDICARE PTAN