Provider Demographics
NPI:1942668009
Name:PODIATRY PLUS, LLC
Entity type:Organization
Organization Name:PODIATRY PLUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-459-1181
Mailing Address - Street 1:2106 N ORANGE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5535
Mailing Address - Country:US
Mailing Address - Phone:407-459-1181
Mailing Address - Fax:
Practice Address - Street 1:110 POND CT
Practice Address - Street 2:SUITE 102
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2709
Practice Address - Country:US
Practice Address - Phone:386-736-7636
Practice Address - Fax:386-742-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty