Provider Demographics
NPI:1558634170
Name:FOOT CLINIC OF DOTHAN, INC.
Entity Type:Organization
Organization Name:FOOT CLINIC OF DOTHAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATING PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:ZWEIG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:334-793-6803
Mailing Address - Street 1:1785 E MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3036
Mailing Address - Country:US
Mailing Address - Phone:334-793-6803
Mailing Address - Fax:334-793-6803
Practice Address - Street 1:1785 E MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3036
Practice Address - Country:US
Practice Address - Phone:334-793-6803
Practice Address - Fax:334-793-6803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL98213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6141210002Medicare NSC