Healthcare Provider Details

I. General information

NPI: 1467671867
Provider Name (Legal Business Name): ADVANCED FOOT CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 LARAMIE ST
CHEYENNE WY
82001-1969
US

IV. Provider business mailing address

4112 LARAMIE ST
CHEYENNE WY
82001-1969
US

V. Phone/Fax

Practice location:
  • Phone: 307-514-9901
  • Fax: 307-275-9880
Mailing address:
  • Phone: 307-514-9901
  • Fax: 307-275-9880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY FISHER
Title or Position: PRESIDENT
Credential: DPM
Phone: 307-514-9901