Healthcare Provider Details

I. General information

NPI: 1124571096
Provider Name (Legal Business Name): THE FOOT AND ANKLE CLINIC OF WEST MONROE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5745 HWY 17
CROWVILLE LA
71230
US

IV. Provider business mailing address

2269 ARKANSAS RD
WEST MONROE LA
71291-7818
US

V. Phone/Fax

Practice location:
  • Phone: 318-397-1574
  • Fax: 318-397-1672
Mailing address:
  • Phone: 318-397-1574
  • Fax: 318-397-1672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM.200054
License Number StateLA

VIII. Authorized Official

Name: LUKE J HUNTER
Title or Position: OWNER/PODIATRIC SURGEON
Credential: DPM
Phone: 318-397-1574