Organization
SUPERIOR PODIATRY, LLC
Active
Other names
st johns foot and ankle specialists, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN RANDALL NORTHRUP DPM (PRESIDENT/OWNER)
(904) 436-8001
Entity
Organization
Contact information
Practice address
1690 US HIGHWAY 1 S STE C, SAINT AUGUSTINE, FL 32084-6024
(904) 436-8001
(904) 377-6776
Mailing address
1690 US HIGHWAY 1 S STE C, SAINT AUGUSTINE, FL 32084-6024
(904) 436-8001
(904) 377-6776
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101522100
—
FL
Enumeration date
07/30/2018
Last updated
11/05/2020
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