Provider Demographics
NPI:1497813430
Name:ADVANCED FOOT AND ANKLE CENTER, PLLC
Entity Type:Organization
Organization Name:ADVANCED FOOT AND ANKLE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PODIATRIC MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:540-343-8755
Mailing Address - Street 1:1121 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4703
Mailing Address - Country:US
Mailing Address - Phone:540-343-8755
Mailing Address - Fax:540-343-4885
Practice Address - Street 1:1121 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4703
Practice Address - Country:US
Practice Address - Phone:540-343-8755
Practice Address - Fax:540-343-4885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300960213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5801480001Medicare NSC
VAC10024Medicare PIN
VADF7350Medicare PIN