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General NPI Number Information
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NPI Number | 1497988828
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Entity Type | Organization
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Legal Business Name | THE FOOT DOCTORS, P.C.
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Dates
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Enumeration Date | 09/02/2009
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Last Update Date | 09/02/2009
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Provider Practice Location Address
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Address Line | 1015 HIGHWAY 248
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City | BRANSON
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State | MO
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Zip | 65616-8001
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Country | US
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Telephone | 417-883-1881
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Fax | 417-883-4844
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Provider Business Mailing Address
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Address Line | 929 E MONTCLAIR ST SUITE 100
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City | SPRINGFIELD
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State | MO
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Zip | 65807-5068
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Country | US
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Telephone | 417-883-1881
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Fax | 417-883-4844
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Authorized Official
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Title or Position | OWNER
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Name | RUSSELL DIRKSEN
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Credential | DPM
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Telephone | 417-883-1881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number |
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License Number State | MO
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