David    Clendenning    DPM
Contract Details
Hollywood Coral Springs Podiat
Facility name
Provider ID
P000005783
NPI
1992749501
Tax ID
202138600
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
4420 Sheridan St Suite C
Hollywood, FL 33021
United States
County
Broward
Phone
9549898850 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address