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General NPI Number Information
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NPI Number | 1003193814
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Entity Type | Organization
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Legal Business Name | LAFAYETTE FOOT AND ANKLE CLINIC LLC
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 2700 LAFAYETTE ST SUITE 100
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City | FORT WAYNE
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State | IN
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Zip | 46806-1100
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Country | US
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Telephone | 260-458-9953
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Fax | 260-458-9238
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Provider Business Mailing Address
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Address Line | 2700 LAFAYETTE ST SUITE 100
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City | FORT WAYNE
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State | IN
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Zip | 46806-1100
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Country | US
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Telephone | 260-458-9953
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Fax | 260-458-9238
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Authorized Official
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Title or Position | CEO
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Name | DR. BENNY FAIR JR.
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Credential | DPM
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Telephone | 260-458-9953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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