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General NPI Number Information
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NPI Number | 1063518132
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Entity Type | Organization
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Legal Business Name | ADVANCED FOOT CLINIC, PC
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 6464 SW BORLAND RD STE B3
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City | TUALATIN
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State | OR
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Zip | 97062-8855
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Country | US
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Telephone | 503-612-4040
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Fax | 503-625-8638
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Provider Business Mailing Address
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Address Line | PO BOX 1550
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City | SHERWOOD
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State | OR
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Zip | 97140-1550
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Country | US
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Telephone | 503-612-4040
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Fax | 503-625-8638
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Authorized Official
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Title or Position | ADMINISTRATOR/MANAGER
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Name | AZADEH ARABSHAHI
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Credential |
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Telephone | 503-391-0688
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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 | DP00296
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License Number State | OR
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