Provider Demographics
NPI:1861808784
Name:SURGICAL FOOT SPECIALITIES P.A.
Entity type:Organization
Organization Name:SURGICAL FOOT SPECIALITIES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DERYCK
Authorized Official - Middle Name:ROMEO
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-346-5077
Mailing Address - Street 1:8190 ROYAL PALM BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5706
Mailing Address - Country:US
Mailing Address - Phone:954-346-5077
Mailing Address - Fax:
Practice Address - Street 1:8190 ROYAL PALM BLVD STE 203
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5706
Practice Address - Country:US
Practice Address - Phone:954-346-5077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3674213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty