Provider Demographics
NPI:1023205820
Name:BRIGHT FOOT CLINIC PA
Entity Type:Organization
Organization Name:BRIGHT FOOT CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:479-750-3131
Mailing Address - Street 1:1670 W SUNSET AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-5136
Mailing Address - Country:US
Mailing Address - Phone:479-750-3131
Mailing Address - Fax:479-750-9631
Practice Address - Street 1:1670 W SUNSET AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-5136
Practice Address - Country:US
Practice Address - Phone:479-750-3131
Practice Address - Fax:479-750-9631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR131213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145942748Medicaid
AR0932990001OtherPALMETTO GBS
AR0932990001Medicare NSC
AR0932990001OtherPALMETTO GBS