Organization
FOOT ANKLE & WOUND CARE CENTER CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANDRA K GORDON DPM (OWNER/CEO)
(904) 666-5170
Entity
Organization
Contact information
Practice address
2262 DUNN AVE, SUITE #3, JACKSONVILLE, FL 32218-4720
(904) 666-5170
Mailing address
2262 DUNN AVE, SUITE #3, JACKSONVILLE, FL 32218-4720
(904) 666-5170
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO3624
FL
213ES0131X
Foot Surgery Podiatrist
PO3308
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010198600
—
FL
Enumeration date
03/23/2016
Last updated
11/17/2016
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