Basic Information
| Provider Information | |||||||||
| NPI: | 1366650160 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAMILY PODIATRY GROUP OF TAMPA, P.A. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 7926 W HILLSBOROUGH AVE | ||||||||
| Address2: | SUITE G | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336154600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138869180 | ||||||||
| FaxNumber: | 8138889093 | ||||||||
| Practice Location | |||||||||
| Address1: | 7926 W HILLSBOROUGH AVE | ||||||||
| Address2: | SUITE G | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336154600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138869180 | ||||||||
| FaxNumber: | 8138889093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 05/01/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RICHTER | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | ARTHUR | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8138869180 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FAMILY PODIATRY GROP OF TAMPA, P.A. | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | D.P.M. | ||||||||
| NPICertificationDate: | 05/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | PO 0001517 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 106079000 | 05 | FL | MEDICAID | 480002605 | 01 | FL | RAILROAD MEDICARE | OTHER |