Organization
ADVANCED WOUND CARE OF NORTH FLORIDA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN DEMETRIOS LAGOUTARIS DPM (OWNER)
(813) 380-1492
Entity
Organization
Contact information
Practice address
13500 SUTTON PARK DR S, SUITE 403, JACKSONVILLE, FL 32224-5251
(904) 493-3390
(904) 493-3395
Mailing address
108 PRINCE PHILLIP DR, ST AUGUSTINE, FL 32092-1746
(813) 380-1492
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
PO3240
FL
213ES0103X
Foot & Ankle Surgery Podiatrist
PO3240
FL
213ES0131X
Foot Surgery Podiatrist
PO3240
FL
Other
Enumeration date
03/10/2015
Last updated
03/10/2015
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