Organization
FIRST COAST FOOT & ANKLE CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIMAL REDDY DPM (OWNER PHYSICIAN)
(904) 739-9129
Entity
Organization
Contact information
Practice address
8075 GATE PKWY W, SUITE 301, JACKSONVILLE, FL 32216-3684
(904) 739-9129
(904) 739-9127
Mailing address
8075 GATE PKWY W, SUITE 301, JACKSONVILLE, FL 32216-3684
(904) 739-9129
(904) 739-9127
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
PO3091
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6330940002
DME PIN
FL
Enumeration date
05/08/2007
Last updated
04/10/2015
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