Healthcare Provider Details

I. General information

NPI: 1770104374
Provider Name (Legal Business Name): THE FOOT AND ANKLE CLINICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 DESIARD ST
MONROE LA
71203-4352
US

IV. Provider business mailing address

3601 DESIARD ST
MONROE LA
71203-4352
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 Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: TAYLOR RECORD
Title or Position: CREDENTIALING COORDINATOR
Credential: CCMA
Phone: 318-397-1574