Advanced Wound Care of North Florida, LLC

Primary specialty

Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X

License

PO3240 Issued in FL

Legal business name

ADVANCED WOUND CARE OF NORTH FLORIDA, LLC

Practice address

13500 Sutton Park Dr S
Suite 403
Jacksonville, FL 32224-5251

Phone

(904) 493-3390

Fax

(904) 493-3395

NPI assigned

Mar 10, 2015

Last updated

Mar 10, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Demetrios Lagoutaris, DPM

Title

Owner

Phone

(813) 380-1492

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1425945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425945600000",
    "number": "1477946820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 PRINCE PHILLIP DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320921746",
            "telephone_number": "813-380-1492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13500 SUTTON PARK DR S",
            "address_2": "SUITE 403",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322245251",
            "telephone_number": "904-493-3390",
            "fax_number": "904-493-3395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED WOUND CARE OF NORTH FLORIDA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-10",
        "last_updated": "2015-03-10",
        "status": "A",
        "authorized_official_last_name": "LAGOUTARIS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "DEMETRIOS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-380-1492",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "FL",
            "license": "PO3240",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO3240",
            "primary": false
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "FL",
            "license": "PO3240",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 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.