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General NPI Number Information
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NPI Number | 1205975968
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Entity Type | Organization
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Legal Business Name | BRIDGETON FOOT AND ANKLE LLC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 12/03/2009
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Provider Practice Location Address
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Address Line | 12255 DE PAUL DR STE. 470
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City | BRIDGETON
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State | MO
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Zip | 63044-2510
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Country | US
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Telephone | 314-739-8863
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Fax | 314-739-6448
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Provider Business Mailing Address
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Address Line | 12255 DE PAUL DR STE. 470
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City | BRIDGETON
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State | MO
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Zip | 63044-2510
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Country | US
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Telephone | 314-739-8863
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Fax | 314-739-6448
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ANTHONY M LOMBARDO
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Credential | D.P.M.
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Telephone | 314-739-8863
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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 | 000551
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License Number State | MO
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