1417132952 NPI number — ODRO, FAZEKAS & WERD PA

Table of content: (NPI 1417132952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417132952 NPI number — ODRO, FAZEKAS & WERD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ODRO, FAZEKAS & WERD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FOOT AND ANKLE ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417132952
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2939 S FLORIDA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33803-4046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-687-3404
Provider Business Mailing Address Fax Number:
863-687-4672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2939 S FLORIDA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33803-4046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-687-3404
Provider Business Practice Location Address Fax Number:
863-687-4672
Provider Enumeration Date:
01/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FAZEKAS
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
863-687-3404

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  PO0000788 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X , with the licence number: PO0001370 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: PO000248 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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