Organization
ST. AUGUSTINE FOOT & ANKLE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS A LEBEAU D.P.M. (OWNER)
(904) 824-0869
Entity
Organization
Contact information
Practice address
1 SAINT JOHNS MEDICAL PARK DR, ST AUGUSTINE, FL 32086-5300
(904) 824-0869
(904) 826-0966
Mailing address
1 SAINT JOHNS MEDICAL PARK DR, ST AUGUSTINE, FL 32086-5300
(904) 824-0869
(904) 826-0966
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001262300
—
FL
01
—
6500E
BLUE CROSS AND BLUE SHIELD OF FLORIDA
FL
Enumeration date
07/09/2009
Last updated
09/30/2023
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