Healthcare Provider Details

I. General information

NPI: 1548301005
Provider Name (Legal Business Name): SOUTHERN DELAWARE FOOT & ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 N SHIPLEY ST SUITE C
SEAFORD DE
19973-2339
US

IV. Provider business mailing address

PO BOX 772
SEAFORD DE
19973-0772
US

V. Phone/Fax

Practice location:
  • Phone: 302-629-3000
  • Fax: 302-629-3080
Mailing address:
  • Phone: 302-629-3613
  • Fax: 302-629-2384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE1-0000121
License Number StateDE

VIII. Authorized Official

Name: BRADLEY T LEMON
Title or Position: OWNER
Credential: DPM
Phone: 302-629-3000