Organization
FLORIDA FOOT & ANKLE GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALTER E ROTH III D.P.M. (TREASURER)
(407) 323-2566
Entity
Organization
Contact information
Practice address
178 WILSHIRE BLVD, CASSELBERRY, FL 32707-5352
(407) 671-8010
(407) 671-4155
Mailing address
522 S HUNT CLUB BLVD # 344, APOPKA, FL 32703-4960
(407) 297-9800
(407) 296-6272
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013593800
—
FL
Enumeration date
02/21/2017
Last updated
02/21/2017
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