MEDICARE: FOOT AND ANKLE CENTER OF DURHAM, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	136	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0278F	OTHER	BCBS GROUP
3	3990735	OTHER	CIGNA IND
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902938152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT AND ANKLE CENTER OF DURHAM, PC

Provider Business Mailing Address
First Line	:	3811 NORTH ROXBORO ROAD
Second Line	:	SUITE A
City	:	DURHAM
State	:	NC
Zip	:	27704-5800
Country	:	US
Telephone Number	:	919-471-1002
Fax Number	:	919-471-2638

Provider Business Practice Location Address
First Line	:	3811 NORTH ROXBORO ROAD
Second Line	:	SUITE A
City	:	DURHAM
State	:	NC
Zip	:	27704-5800
Country	:	US
Telephone Number	:	919-471-1002
Fax Number	:	919-471-2638

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERIC SIMMONS
Credential	:	DPM
Telephone Number	:	919-471-1002

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	02/27/2012

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Directions to “FOOT AND ANKLE CENTER OF DURHAM, PC ” Practice Location

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