Ambulatory Foot Center Pc

NPI 1063630291 - Podiatrist - 213ES0103X

NPI Details
NPI 1063630291
Enumeration Date 04/23/2007
Last Updated 08/21/2009
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name MARK L MARK
Position EXCUTIVE OFFICER
Phone (541) 471-7056
Fax
Practice Location
1619 NW HAWTHORNE AVE STE 110
GRANTS PASS OR, 97526-6008, US
Phone (541) 471-7056
Fax
Business Location
1619 NW HAWTHORNE AVE
STE 110
GRANTS PASS OR, 97526-6008, US
Phone (541) 471-7056
Fax
Toxanomy
Taxonomy Code 213ES0103X
License State Oregon
License Number DP00291
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According to our database, Ambulatory Foot Center Pc NPI is 1063630291, taxonomy code is 213ES0103X and license number is DP00291, license state is located at Oregon. Ambulatory Foot Center Pc physically located at 1619 Nw Hawthorne Ave Ste 110, Grants Pass OR, 97526-6008. NPI Number 1033115704 has the healthcare provider type.

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1063630291 NPI number is provided on an as is basis without warranty of any kind. 1063630291 is maintained by the National Plan & Provider Enumeration System. The contents of Ambulatory Foot Center Pc are for informational purposes only.