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General NPI Number Information
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NPI Number | 1407177694
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Entity Type | Organization
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Legal Business Name | AFFORDABLE FOOT AND LEG, LLC
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Dates
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Enumeration Date | 06/22/2010
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Last Update Date | 04/11/2012
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Provider Practice Location Address
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Address Line | 2100 E HALLANDALE BEACH BLVD SUITE 204
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-3765
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Country | US
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Telephone | 954-458-1248
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Fax | 954-458-1256
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Provider Business Mailing Address
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Address Line | 2100 E HALLANDALE BEACH BLVD SUITE 204
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-3765
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Country | US
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Telephone | 954-458-1248
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Fax | 954-458-1256
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Authorized Official
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Title or Position | OWNER
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Name | DR. CRAIG B STAM
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Credential | DPM
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Telephone | 954-458-1248
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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 | PO 3321
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License Number State | FL
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