Elite Sports Podiatry, PA

Primary specialty

Foot Surgery PodiatristTaxonomy code 213ES0131X

License

PO3445 Issued in FL

Legal business name

ELITE SPORTS PODIATRY, PA

Practice address

1700 N McMullen Booth Rd
Suite C-2
Clearwater, FL 33759-2130

Phone

(727) 330-7646

Fax

(727) 330-4645

NPI assigned

Sep 23, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Brian William Fullem, MDNPI 1922036086

Title

Medical Doctor/Owner

Phone

(203) 241-2582

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brian William Fullem, DPM

  • Foot Surgery Podiatrist
  • Clearwater, FL
  • NPI 1922036086
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1411430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420588800000",
    "number": "1356743207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 N MCMULLEN BOOTH RD STE C2",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337592129",
            "telephone_number": "727-330-7646",
            "fax_number": "727-330-7645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 N MCMULLEN BOOTH RD",
            "address_2": "SUITE C-2",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337592130",
            "telephone_number": "727-330-7646",
            "fax_number": "727-330-4645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE SPORTS PODIATRY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-23",
        "last_updated": "2015-01-07",
        "status": "A",
        "authorized_official_last_name": "FULLEM",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "MEDICAL DOCTOR/OWNER",
        "authorized_official_telephone_number": "203-241-2582",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": "FL",
            "license": "PO3445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elena Jean Lemanski LMT
• Bolanle Elenitoba-Johnson, APRN
• Nina Eliacin, PMHNP-BC
• Elias Kanaan MD PA
• Elite Injury Physicians LLC
• Jeffrey Ellenberg, DMD
• Cynthia Lee Elliott, M.D.
• Emily R Elliott, PT
• Janie R Elliott, A.R.N.P.
• Jessica Rose Ellis, RN

• Foot Surgery Podiatrist in Clearwater, FL
• Providers in Clearwater, FL by specialty
• Foot Surgery Podiatrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.