Organization
MARK G LEITNER DPM
Active
Other names
ADVANCED FOOT AND ANKLE SPECIALISTS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK G LEITNER DPM (MEDICAL DIRECTOR)
(813) 571-2977
Entity
Organization
Contact information
Practice address
132 S MOON AVE, BRANDON, FL 33511-5110
(813) 571-2977
Mailing address
3638 LITHIA PINECREST RD, VALRICO, FL 33596-6305
(813) 657-9669
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO2569
FL
213E00000X
Podiatrist
PO3189
FL
213EP1101X
Primary Podiatric Medicine Podiatrist
PO2569
FL
213EP1101X
Primary Podiatric Medicine Podiatrist
PO3199
FL
213ES0103X
Foot & Ankle Surgery Podiatrist
PO2569
FL
213ES0103X
Foot & Ankle Surgery Podiatrist
PO3199
FL
213ES0131X
Foot Surgery Podiatrist
PO2569
FL
213ES0131X
Foot Surgery Podiatrist
PO3199
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340534600
—
FL
05
—
390319200
—
FL
01
—
65462
BCBS - LEITNER
FL
01
—
65891
BCBS - JOHNSON
FL
01
—
DG1014
RAILROAD MEDICARE
FL
01
—
PO2569
MEDICAL LICENSE - LEITNER
FL
01
—
PO3199
MEDICAL LICENSE - JOHNSON
FL
Enumeration date
05/30/2008
Last updated
05/30/2008
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