Provider Demographics
NPI:1356487151
Name:FOOT AND ANKLE PHYSICIANS WEST P.A.
Entity Type:Organization
Organization Name:FOOT AND ANKLE PHYSICIANS WEST P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:MOELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:952-934-9360
Mailing Address - Street 1:7770 DELL RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-9314
Mailing Address - Country:US
Mailing Address - Phone:952-934-9360
Mailing Address - Fax:952-975-0118
Practice Address - Street 1:7770 DELL RD
Practice Address - Street 2:SUITE 140
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-9314
Practice Address - Country:US
Practice Address - Phone:952-934-9360
Practice Address - Fax:952-975-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN396213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN203525100Medicaid
MN913525100Medicaid
MN480000112Medicare PIN
MNT39518Medicare UPIN
MN913525100Medicaid
MNT39925Medicare UPIN
MN480000113Medicare PIN