Provider Demographics
NPI:1033441423
Name:AURORA FOOT & ANKLE SURGICAL SPECIALISTS, LLC
Entity Type:Organization
Organization Name:AURORA FOOT & ANKLE SURGICAL SPECIALISTS, LLC
Other - Org Name:MANX QUAYLE, DPM LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DPM/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANX
Authorized Official - Middle Name:D
Authorized Official - Last Name:QUAYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:907-456-3668
Mailing Address - Street 1:1626 30TH AVE STE 202
Mailing Address - Street 2:AURORA FOOT & ANKLE SURGICAL SPECIALISTS LLC
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701
Mailing Address - Country:US
Mailing Address - Phone:901-456-3668
Mailing Address - Fax:901-456-8637
Practice Address - Street 1:1626 30TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701
Practice Address - Country:US
Practice Address - Phone:901-456-3668
Practice Address - Fax:901-456-8637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK939216213E00000X
AK8164213E00000X
AK5079213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1023083870OtherNPPES