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General NPI Number Information
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NPI Number | 1376916742
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Entity Type | Organization
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Legal Business Name | ANKLE AND FOOT CLINIC OF ENID, LLC
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Dates
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Enumeration Date | 11/07/2015
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Last Update Date | 11/07/2015
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Provider Practice Location Address
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Address Line | 915 E GARRIOTT RD SUITE J
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City | ENID
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State | OK
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Zip | 73701-6156
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Country | US
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Telephone | 580-297-5184
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Fax | 580-297-5187
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Provider Business Mailing Address
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Address Line | 915 E GARRIOTT RD SUITE J
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City | ENID
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State | OK
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Zip | 73701-6156
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Country | US
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Telephone | 580-297-5184
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Fax | 580-297-5187
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. EDWARD ALEXANDER LEBRIJA
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Credential | D.P.M.
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Telephone | 580-297-5184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 304
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License Number State | OK
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