Healthcare Provider Details

I. General information

NPI: 1952923708
Provider Name (Legal Business Name): FOOT DOC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 N MCQUEEN RD STE 1
CHANDLER AZ
85225-8129
US

IV. Provider business mailing address

955 N MCQUEEN RD STE 1
CHANDLER AZ
85225-8129
US

V. Phone/Fax

Practice location:
  • Phone: 480-744-6234
  • Fax: 480-907-0500
Mailing address:
  • Phone: 480-744-6234
  • Fax: 480-907-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN O'BRYANT
Title or Position: OWNER
Credential:
Phone: 480-744-6234