Provider Demographics
NPI:1619149788
Name:ATLANTIC FOOT AND ANKLE LLC
Entity type:Organization
Organization Name:ATLANTIC FOOT AND ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-852-8395
Mailing Address - Street 1:PO BOX 378485
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-8485
Mailing Address - Country:US
Mailing Address - Phone:305-852-8395
Mailing Address - Fax:305-852-8397
Practice Address - Street 1:92410 OVERSEAS HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2636
Practice Address - Country:US
Practice Address - Phone:305-942-9842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-29
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty