Individual
JOHN RANDALL NORTHRUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
1690 US HIGHWAY 1 S STE C, ST AUGUSTINE, FL 32084-6024
(904) 436-8001
(904) 377-6776
Mailing address
1690 US HIGHWAY 1 S STE C, ST AUGUSTINE, FL 32084-6024
(904) 436-8001
(904) 376-7761
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
PO3952
FL
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO3952
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101521600
—
FL
Enumeration date
06/30/2015
Last updated
10/31/2023
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