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General NPI Number Information
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NPI Number | 1255505004
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Entity Type | Organization
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Legal Business Name | A FOOT DOCTOR, PLLC
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 08/02/2010
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Provider Practice Location Address
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Address Line | 2631 12TH AVE S
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City | FARGO
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State | ND
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Zip | 58103-8741
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Country | US
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Telephone | 701-232-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 2631 12TH AVE S
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City | FARGO
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State | ND
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Zip | 58103-8741
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Country | US
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Telephone | 701-232-0900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRUCE MORGAN
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Credential | DPM
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Telephone | 701-232-0900
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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 | 52
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License Number State | ND
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