Organization
PEACE RIVER ANKLE & FOOT, PL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOLLY K WADDELL DPM (OWNER/PODIATRIST)
(941) 624-3668
Entity
Organization
Contact information
Practice address
3440 CONWAY BLVD, 1D, PORT CHARLOTTE, FL 33952-7000
(941) 624-3668
Mailing address
3440 CONWAY BLVD, 1D, PORT CHARLOTTE, FL 33952-7000
(941) 624-3668
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO3264
FL
Other
Enumeration date
07/01/2010
Last updated
03/03/2011
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