Provider Demographics
NPI:1063648533
Name:ANKLE AND FOOT SURGICAL AND PODIATRY CLINIC PA
Entity Type:Organization
Organization Name:ANKLE AND FOOT SURGICAL AND PODIATRY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HARO
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:910-295-7400
Mailing Address - Street 1:200 WESTGATE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST END
Mailing Address - State:NC
Mailing Address - Zip Code:27376-8038
Mailing Address - Country:US
Mailing Address - Phone:910-295-7400
Mailing Address - Fax:910-295-0104
Practice Address - Street 1:200 WESTGATE DR
Practice Address - Street 2:SUITE A
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376-8038
Practice Address - Country:US
Practice Address - Phone:910-295-7400
Practice Address - Fax:910-295-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC493213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2430184BMedicare PIN
NC6253660001Medicare NSC