MEDICARE: SUN CITY FOOT CARE

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	213ES0103X	Foot & Ankle Surgery Podiatrist	9804	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	480029166	OTHER	NV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CC1573	OTHER	NV	BLUE CROSS BLUE SHIELD
2	1943324	OTHER	NV	UNITED HEALTH CARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	7208106	OTHER	NV	AETNA

General Provider Information

NPI Number	:	1710001961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN CITY FOOT CARE

Provider Business Mailing Address
First Line	:	3320 NORTH BUFFALO DRIVE
Second Line	:	STE 107
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7410
Country	:	US
Telephone Number	:	702-256-8454
Fax Number	:	702-256-0387

Provider Business Practice Location Address
First Line	:	3320 NORTH BUFFALO DRIVE
Second Line	:	STE 107
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7410
Country	:	US
Telephone Number	:	702-256-8454
Fax Number	:	702-256-0387

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RANDY LEE GUBLER
Credential	:	D.P.M.
Telephone Number	:	702-256-8454

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	12/05/2014

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Directions to “SUN CITY FOOT CARE ” Practice Location

Language	Start Address	Practice Location

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