Provider Demographics
NPI:1669574521
Name:PERRONE AND GOGGIN DPM LC
Entity type:Organization
Organization Name:PERRONE AND GOGGIN DPM LC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GOGGIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:772-461-4400
Mailing Address - Street 1:2209 S 25TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4796
Mailing Address - Country:US
Mailing Address - Phone:772-461-4400
Mailing Address - Fax:772-461-4409
Practice Address - Street 1:2209 S 25TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4796
Practice Address - Country:US
Practice Address - Phone:772-461-4400
Practice Address - Fax:772-461-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340558300Medicaid
5574550001Medicare NSC
77297Medicare PIN
5574550001Medicare NSC