Provider Demographics
NPI:1003125600
Name:FOOT AND ANKLE CLINIC OF NORTHERN
Entity Type:Organization
Organization Name:FOOT AND ANKLE CLINIC OF NORTHERN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:STODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:530-342-5621
Mailing Address - Street 1:676 E 1ST AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3547
Mailing Address - Country:US
Mailing Address - Phone:530-342-5621
Mailing Address - Fax:530-342-6506
Practice Address - Street 1:676 E 1ST AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3547
Practice Address - Country:US
Practice Address - Phone:530-342-5621
Practice Address - Fax:530-342-6506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4852213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEI311AMedicare PIN
CA6463970001Medicare NSC
CAT95618Medicare UPIN