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Organization
THE DOCTORS SHOE STORE
Active
Organization
THE DOCTORS SHOE STORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL MILES BLATSTEIN DPM (OWNER)
(772) 380-9998
Entity
Organization
Contact information
Practice address
1228 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34952-5330
(772) 380-9998
Mailing address
1228 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34952-5330
(772) 380-9998
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
121954071029341
FL
Other
Enumeration date
12/12/2006
Last updated
08/22/2020
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