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General NPI Number Information
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NPI Number | 1427616796
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Entity Type | Organization
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Legal Business Name | FOOT AND ANKLE SURGEONS OF NORTHERN CALIFORNIA
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Dates
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Enumeration Date | 06/03/2019
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Last Update Date | 06/03/2019
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Provider Practice Location Address
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Address Line | 150 CATHERINE LN STE B
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City | GRASS VALLEY
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State | CA
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Zip | 95945-5719
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Country | US
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Telephone | 530-271-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 150 CATHERINE LN STE B
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City | GRASS VALLEY
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State | CA
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Zip | 95945-5719
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Country | US
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Telephone | 530-271-2100
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MARC CLAYDON
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Credential | DPM
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Telephone | 530-271-2100
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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 |
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License Number State |
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