Provider Demographics
NPI:1871545384
Name:AMERICAN FOOT CLINICS OF JACKSONVILLE INC
Entity type:Organization
Organization Name:AMERICAN FOOT CLINICS OF JACKSONVILLE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:904-655-0812
Mailing Address - Street 1:PO BOX 331357
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233
Mailing Address - Country:US
Mailing Address - Phone:904-655-0812
Mailing Address - Fax:
Practice Address - Street 1:14176 DRAKES POINT DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2840
Practice Address - Country:US
Practice Address - Phone:904-355-1553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP01805213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0296619Medicaid
FL87935YMedicare PIN
FL0296619Medicaid
87935Medicare ID - Type Unspecified