Provider Demographics
NPI:1003432204
Name:FRONTIER FOOT AND ANKLE SPECIALISTS LLC
Entity Type:Organization
Organization Name:FRONTIER FOOT AND ANKLE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEBUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-537-8352
Mailing Address - Street 1:780 2ND ST SE # 10
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-8354
Mailing Address - Country:US
Mailing Address - Phone:971-247-1080
Mailing Address - Fax:971-223-3243
Practice Address - Street 1:780 2ND ST SE # 10
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-8354
Practice Address - Country:US
Practice Address - Phone:971-247-1080
Practice Address - Fax:971-223-3243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty