Organization
FOOTCARE STORE INC
Active
Other names
DIA-Foot
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT M GAYNON DPM (PRESIDENT)
(561) 641-2647
Entity
Organization
Contact information
Practice address
6316 LANTANA RD, SUITE 34, LAKE WORTH, FL 33463-6679
(561) 641-2647
(561) 642-1590
Mailing address
6316 LANTANA RD, SUITE 34, LAKE WORTH, FL 33463-6679
(561) 641-2647
(561) 642-1590
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4036910001
DME #
FL
Enumeration date
08/30/2006
Last updated
08/22/2020
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