Organization
PODIATRY CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID IRA METZENDORF DPM (PRESIDENT)
(863) 293-1968
Entity
Organization
Contact information
Practice address
135 1ST ST SOUTH, WINTER HAVEN, FL 33880
(863) 293-1968
(863) 293-7961
Mailing address
135 1ST ST SOUTH, WINTER HAVEN, FL 33880
(863) 293-1968
(863) 293-7961
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO 0001385
FL
213E00000X
Podiatrist
PO 0002193
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477661395
NPI
FL
01
—
40418
MEDICARE ID
FL
Enumeration date
08/29/2006
Last updated
04/20/2008
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