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General NPI Number Information
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NPI Number | 1033376959
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Entity Type | Organization
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Legal Business Name | WAKE FOOT AND ANKLE CENTER PLLC
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 833 WAKE FOREST BUSINESS PARK STE C
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City | WAKE FOREST
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State | NC
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Zip | 27587-6519
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Country | US
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Telephone | 919-570-9061
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Fax | 919-570-9064
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Provider Business Mailing Address
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Address Line | 833 WAKE FOREST BUSINESS PARK STE C
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City | WAKE FOREST
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State | NC
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Zip | 27587-6519
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Country | US
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Telephone | 919-570-9061
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Fax | 919-570-9064
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. LEAH M JUDGE
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Credential |
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Telephone | 919-570-9061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 389
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License Number State | NC
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