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General NPI Number Information
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NPI Number | 1225158397
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Entity Type | Organization
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Legal Business Name | FOOT AND ANKLE CENTER LLC
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 04/25/2008
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Provider Practice Location Address
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Address Line | 1111 MEDICAL CENTER BLVD SUITE N507
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City | MARRERO
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State | LA
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Zip | 70072-3151
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Country | US
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Telephone | 504-349-6633
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Fax | 504-349-6631
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Provider Business Mailing Address
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Address Line | 1111 MEDICAL CENTER BLVD #N-507
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City | MARRERO
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State | LA
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Zip | 70072-3151
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Country | US
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Telephone | 504-349-6633
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Fax | 504-349-6631
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DENISE LEA ELLIOTT
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Credential | DMP
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Telephone | 504-349-6633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | PD228R
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License Number State | LA
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