Provider Demographics
NPI:1255505004
Name:A FOOT DOCTOR, PLLC
Entity Type:Organization
Organization Name:A FOOT DOCTOR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:701-232-0900
Mailing Address - Street 1:2631 12TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8741
Mailing Address - Country:US
Mailing Address - Phone:701-232-0900
Mailing Address - Fax:
Practice Address - Street 1:2631 12TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8741
Practice Address - Country:US
Practice Address - Phone:701-232-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND52213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN126502OtherHEALTHPARTNERS HPFIN
ND13725Medicaid
ND06796001OtherBLUE SHIELD GROUP
MN03N87MOOtherBLUE SHIELD MN GROUP
MN2700617OtherMEDICA
P00320486OtherRAILROAD MEDICARE
MN2700617OtherMEDICA
NDT02601Medicare UPIN
ND13725Medicaid