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General NPI Number Information
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NPI Number | 1336471838
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Entity Type | Organization
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Legal Business Name | FAMILY FOOT AND ANKLE CLINIC
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Dates
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Enumeration Date | 02/08/2010
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Last Update Date | 03/03/2010
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Provider Practice Location Address
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Address Line | 3626 YOUREE DR
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City | SHREVEPORT
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State | LA
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Zip | 71105-2122
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Country | US
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Telephone | 318-869-2960
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Fax | 318-869-2958
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Provider Business Mailing Address
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Address Line | 3626 YOUREE DR
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City | SHREVEPORT
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State | LA
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Zip | 71105-2122
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Country | US
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Telephone | 318-869-2960
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Fax | 318-869-2958
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. EDOZIE CHUKWUDINMA OKEREKE
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Credential | DPM
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Telephone | 318-869-2960
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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 | PD196R
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License Number State | LA
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