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General NPI Number Information
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NPI Number | 1326355280
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Entity Type | Organization
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Legal Business Name | FOOT & ANKLE SPECIALTY CLINIC INC.
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Dates
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Enumeration Date | 09/13/2010
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Last Update Date | 09/13/2010
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Provider Practice Location Address
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Address Line | 1714 KINGS HWY
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City | SHREVEPORT
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State | LA
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Zip | 71103-4152
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Country | US
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Telephone | 318-636-2669
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Fax | 318-636-2663
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Provider Business Mailing Address
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Address Line | 1714 KINGS HWY
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City | SHREVEPORT
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State | LA
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Zip | 71103-4152
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Country | US
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Telephone | 318-636-2669
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Fax | 318-636-2663
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALAYE ELDRED WHYTE
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Credential | DPM
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Telephone | 318-636-2669
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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 | PD166R
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License Number State | LA
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