Healthcare Provider Details

I. General information

NPI: 1669509360
Provider Name (Legal Business Name): ALL FOOT CARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 S PEACE HAVEN RD
WINSTON SALEM NC
27103-9788
US

IV. Provider business mailing address

1050 S PEACE HAVEN RD
WINSTON SALEM NC
27103-9788
US

V. Phone/Fax

Practice location:
  • Phone: 336-766-3338
  • Fax: 336-766-3990
Mailing address:
  • Phone: 336-766-3338
  • Fax: 336-766-3990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT C WINGATE
Title or Position: PRESIDENT
Credential: DPM
Phone: 336-766-3338