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General NPI Number Information
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NPI Number | 1528484904
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Entity Type | Organization
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Legal Business Name | FAMILY FOOT & ANKLE CARE OF JASPER, PC
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Dates
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Enumeration Date | 03/10/2014
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Last Update Date | 02/01/2019
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Provider Practice Location Address
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Address Line | 695 W 2ND ST STE C
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City | JASPER
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State | IN
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Zip | 47546
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Country | US
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Telephone | 812-481-7200
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Fax | 812-481-7201
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Provider Business Mailing Address
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Address Line | 695 W 2ND ST STE C
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City | JASPER
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State | IN
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Zip | 47546-3240
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Country | US
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Telephone | 812-481-7200
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Fax | 812-481-7201
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY BARRY
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Credential | DPM
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Telephone | 812-481-2741
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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 | 07001046A
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License Number State | IN
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