| Organization Name: | FOOT FIRST PODIATRY |
| NPI Number: | 1053658963 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KELVIN DEVANE GIPSON (OWNER) |
| Mailing Address: | 2600 Hospital Dr Bonifay |
| State: | FL US |
| Postal Code: | 324254264 |
| Phone Number: | 8505478117 |
| Fax Number: | 8505478090 |
| NPI Enumeration Date: | 01/11/2013 |
| NPI Last Update Date: | 01/11/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | PO 2195 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |