Provider Demographics
NPI:1376916742
Name:ANKLE AND FOOT CLINIC OF ENID, LLC
Entity Type:Organization
Organization Name:ANKLE AND FOOT CLINIC OF ENID, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:LEBRIJA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:580-297-5184
Mailing Address - Street 1:915 E GARRIOTT RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-6156
Mailing Address - Country:US
Mailing Address - Phone:580-297-5184
Mailing Address - Fax:580-297-5187
Practice Address - Street 1:915 E GARRIOTT RD
Practice Address - Street 2:SUITE J
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-6156
Practice Address - Country:US
Practice Address - Phone:580-297-5184
Practice Address - Fax:580-297-5187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-07
Last Update Date:2015-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK304213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty