=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952535577
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOOT AND ANKLE INSTITUTE OF SAN FRANCISCO INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2009
-----------------------------------------------------
Last Update Date | 03/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 SUTTER ST SUITE 1404
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94108-4206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-433-3668
-----------------------------------------------------
Fax | 415-762-4243
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 450 SUTTER ST SUITE 1404
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94108-4206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-433-3668
-----------------------------------------------------
Fax | 415-762-4243
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOOT AND ANKLE SURGEON, PRINCIPAL
-----------------------------------------------------
Name | DR. BILL J METAXAS
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 415-377-2625
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | E4757
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------