Provider Demographics
NPI:1427190206
Name:DAKOTA FOOT AND ANKLE CLINIC PC
Entity Type:Organization
Organization Name:DAKOTA FOOT AND ANKLE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GALE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:701-255-3338
Mailing Address - Street 1:1733 E CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-2150
Mailing Address - Country:US
Mailing Address - Phone:701-255-3338
Mailing Address - Fax:701-255-6706
Practice Address - Street 1:1733 E CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-2150
Practice Address - Country:US
Practice Address - Phone:701-255-3338
Practice Address - Fax:701-255-6706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND29213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12198Medicaid
ND12198Medicaid
ND0650330001Medicare NSC
NDN70666Medicare ID - Type UnspecifiedGROUP #