Provider Demographics
NPI:1245751692
Name:FLORIDA FOOT AND ANKLE,INC
Entity type:Organization
Organization Name:FLORIDA FOOT AND ANKLE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MATEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:904-268-3686
Mailing Address - Street 1:13241 BARTRAM PARK BLVD UNIT 1805
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5227
Mailing Address - Country:US
Mailing Address - Phone:904-268-3686
Mailing Address - Fax:904-268-7718
Practice Address - Street 1:13241 BARTRAM PARK BLVD UNIT 1805
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5227
Practice Address - Country:US
Practice Address - Phone:904-268-3686
Practice Address - Fax:904-268-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2521213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty