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General NPI Number Information
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NPI Number | 1093770521
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Entity Type | Organization
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Legal Business Name | PIEDMONT PODIATRY ASSOCIATES
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 10/26/2007
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Provider Practice Location Address
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Address Line | 15 CLEVELAND AVE SUITE 9
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City | MARTINSVILLE
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State | VA
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Zip | 24112-2937
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Country | US
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Telephone | 276-632-5280
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Fax | 276-632-5257
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Provider Business Mailing Address
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Address Line | 15 CLEVELAND AVE SUITE 9
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City | MARTINSVILLE
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State | VA
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Zip | 24112-2937
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Country | US
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Telephone | 276-632-5280
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Fax | 276-632-5257
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID TUCKER
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Credential |
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Telephone | 276-632-5280
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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 | 449
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License Number State | VA
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