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General NPI Number Information
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NPI Number | 1467889543
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Entity Type | Organization
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Legal Business Name | ASHTABULA FOOT AND ANKLE SURGEONS INC
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 1604 W 19TH ST
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City | ASHTABULA
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State | OH
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Zip | 44004-3036
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Country | US
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Telephone | 440-964-5595
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Fax | 440-964-5003
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Provider Business Mailing Address
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Address Line | 1604 W 19TH ST
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City | ASHTABULA
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State | OH
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Zip | 44004-3036
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Country | US
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Telephone | 440-964-5595
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Fax | 440-964-5003
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Authorized Official
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Title or Position | OWNER
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Name | DR. DONALD RAYMOND FARLEY
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Credential | D.P.M.
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Telephone | 440-964-5595
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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 | 36002243
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License Number State | OH
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