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Organization
SUPERIOR PODIATRY, LLC
Active
Organization
SUPERIOR PODIATRY, LLC
Active
Other names
st johns foot and ankle specialists, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN RANDALL NORTHRUP DPM (PRESIDENT/OWNER)
(904) 436-8001
Entity
Organization
Contact information
Practice address
1690 US HIGHWAY 1 S STE C, SAINT AUGUSTINE, FL 32084-6024
(904) 436-8001
(904) 377-6776
Mailing address
1690 US HIGHWAY 1 S STE C, SAINT AUGUSTINE, FL 32084-6024
(904) 436-8001
(904) 377-6776
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
—
NULL
213E00000X
Podiatrist
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
NULL
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Enumeration date
07/30/2018
Last updated
11/05/2020
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