Healthcare Provider Details

I. General information

NPI: 1205523602
Provider Name (Legal Business Name): ANTONIO SIERRA D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 S ANDY GRIFFITH PKWY STE 200
MOUNT AIRY NC
27030-4010
US

IV. Provider business mailing address

1036 BRANCHVIEW DR STE 216
CONCORD NC
28025-0113
US

V. Phone/Fax

Practice location:
  • Phone: 336-443-9190
  • Fax:
Mailing address:
  • Phone: 704-886-1918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number877
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number877
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number877
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: