Healthcare Provider Details

I. General information

NPI: 1467675124
Provider Name (Legal Business Name): BATON ROUGE FOOT CARE , PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8160 YMCA PLAZA DR STE C
BATON ROUGE LA
70810-0916
US

IV. Provider business mailing address

8160 YMCA PLAZA DR STE C
BATON ROUGE LA
70810-0916
US

V. Phone/Fax

Practice location:
  • Phone: 225-763-7770
  • Fax: 225-763-7773
Mailing address:
  • Phone: 225-763-7770
  • Fax: 225-763-7773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPD317R
License Number StateLA

VIII. Authorized Official

Name: CLIF S RICHARDSON
Title or Position: ADMINISTRATOR
Credential: DPM
Phone: 225-763-7770