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General NPI Number Information
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NPI Number | 1528650744
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Entity Type | Organization
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Legal Business Name | EASTERN VIRGINIA FOOT AND ANKLE PLLC
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Dates
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Enumeration Date | 02/09/2021
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 109 WIMBLEDON SQ STE F
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4945
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Country | US
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Telephone | 757-979-4028
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Fax |
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Provider Business Mailing Address
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Address Line | 109 WIMBLEDON SQ STE F
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4945
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Country | US
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Telephone | 757-979-4028
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Fax |
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Authorized Official
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Title or Position | MANAGER/DPM
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Name | DR. YUN PAN
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Credential | DPM
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Telephone | 757-698-4177
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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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