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General NPI Number Information
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NPI Number | 1316137615
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Entity Type | Organization
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Legal Business Name | OFALLON FOOT CARE CENTER
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 08/01/2007
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Provider Practice Location Address
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Address Line | 4132 KEATON CROSSING BLVD
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City | O FALLON
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State | MO
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Zip | 63368-8222
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Country | US
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Telephone | 636-300-1114
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Fax | 636-300-1152
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Provider Business Mailing Address
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Address Line | 4132 KEATON CROSSING BLVD
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City | O FALLON
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State | MO
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Zip | 63368-8222
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Country | US
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Telephone | 636-300-1114
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Fax | 636-300-1152
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MARK P COMESS
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Credential | DPM
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Telephone | 636-300-1114
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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 |
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License Number State |
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