Healthcare Provider Details

I. General information

NPI: 1508838939
Provider Name (Legal Business Name): DONALD R ANSERT JR. D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 GREEN VALLEY RD STE. 200
NEW ALBANY IN
47150-4649
US

IV. Provider business mailing address

2315 GREEN VALLEY RD STE. 200
NEW ALBANY IN
47150-4649
US

V. Phone/Fax

Practice location:
  • Phone: 812-949-1002
  • Fax: 812-949-1007
Mailing address:
  • Phone: 812-949-1002
  • Fax: 812-949-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number231
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07000824A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: