Provider Demographics
NPI:1003124140
Name:SHORES FOOT AND ANKLE CENTER LTD.
Entity Type:Organization
Organization Name:SHORES FOOT AND ANKLE CENTER LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:FARRAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-484-7277
Mailing Address - Street 1:22719 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-1857
Mailing Address - Country:US
Mailing Address - Phone:586-484-7277
Mailing Address - Fax:
Practice Address - Street 1:22719 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-1857
Practice Address - Country:US
Practice Address - Phone:586-294-7250
Practice Address - Fax:586-294-7251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty