| Organization Name: | MAGNOLIA PODIATRY ASSOCIATES PA |
| NPI Number: | 1033317995 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EDWARD L WEINER (PRESIDENT) |
| Mailing Address: | 7727 Southampton Ter Suite 412-f Tamarac |
| State: | FL US |
| Postal Code: | 333219101 |
| Phone Number: | 9547216010 |
| Fax Number: | |
| NPI Enumeration Date: | 07/03/2007 |
| NPI Last Update Date: | 12/30/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | PO3137 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |