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General NPI Number Information
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NPI Number | 1689850638
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Entity Type | Organization
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Legal Business Name | ADVANCED FOOT AND ANKLE SPECIALISTS, INC.
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Dates
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Enumeration Date | 01/21/2008
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Last Update Date | 05/06/2013
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Provider Practice Location Address
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Address Line | 78-437 HWY 111
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City | LA QUINTA
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State | CA
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Zip | 92253
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Country | US
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Telephone | 760-674-3355
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Fax | 760-771-5149
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Provider Business Mailing Address
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Address Line | 42-335 WASHINGTON F-338
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City | PALM DESERT
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State | CA
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Zip | 92211
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Country | US
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Telephone | 760-674-3355
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Fax | 760-771-5149
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Authorized Official
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Title or Position | CEO
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Name | DR. DALE SHRUM
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Credential | DPM
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Telephone | 760-674-3355
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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 | E3589
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E-3589
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License Number State | CA
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