Healthcare Provider Details

I. General information

NPI: 1235666710
Provider Name (Legal Business Name): CAPITAL FOOT AND ANKLE CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 04/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 GLENWOOD AVE
RALEIGH NC
27608-2368
US

IV. Provider business mailing address

1514 GLENWOOD AVE
RALEIGH NC
27608-2368
US

V. Phone/Fax

Practice location:
  • Phone: 919-619-7310
  • Fax:
Mailing address:
  • Phone: 919-829-0076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number656
License Number StateNC

VIII. Authorized Official

Name: ELDON PETERS
Title or Position: OWNER/PHYSICIAN
Credential: DPM
Phone: 919-829-0076