Healthcare Provider Details

I. General information

NPI: 1922169424
Provider Name (Legal Business Name): TUSCALOOSA FOOT CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 WATERMELON RD
NORTHPORT AL
35473-5174
US

IV. Provider business mailing address

3515 WATERMELON RD
NORTHPORT AL
35473-5174
US

V. Phone/Fax

Practice location:
  • Phone: 205-366-0032
  • Fax: 205-366-0610
Mailing address:
  • Phone: 205-366-0032
  • Fax: 205-366-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number201
License Number StateAL

VIII. Authorized Official

Name: DR. DAVID VANCE ROBINSON
Title or Position: PRESIDENT
Credential: DPM
Phone: 205-366-0032