MEDICARE: ADVANCED FOOT CARE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist	134	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08630	OTHER	AL	BCBS OF ALABAMA

General Provider Information

NPI Number	:	1467647446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED FOOT CARE PC

Provider Business Mailing Address
First Line	:	7956 VAUGH RODE
Second Line	:	#193
City	:	MONTGOMERY
State	:	AL
Zip	:	36116
Country	:	US
Telephone Number	:	334-233-3364
Fax Number	:	334-271-3768

Provider Business Practice Location Address
First Line	:	348 SAINT LUKES DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-7108
Country	:	US
Telephone Number	:	334-271-3333
Fax Number	:	334-271-3768

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	DR. THERESA IOLA BROWN
Credential	:	DPM
Telephone Number	:	334-271-3333

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	12/20/2007

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Directions to “ADVANCED FOOT CARE PC ” Practice Location

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