Healthcare Provider Details

I. General information

NPI: 1609834795
Provider Name (Legal Business Name): ALLAN SCOTT WAX DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13048 RIVERS BEND RD
CHESTER VA
23836-2564
US

IV. Provider business mailing address

13000 RIVERS BEND BLVD SUITE D
CHESTER VA
23836-8632
US

V. Phone/Fax

Practice location:
  • Phone: 804-526-5888
  • Fax: 804-526-5401
Mailing address:
  • Phone: 804-571-5106
  • Fax: 804-530-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103000780
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: