Provider Demographics
NPI:1689850638
Name:ADVANCED FOOT AND ANKLE SPECIALISTS, INC.
Entity Type:Organization
Organization Name:ADVANCED FOOT AND ANKLE SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRUM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:760-674-3355
Mailing Address - Street 1:42-335 WASHINGTON F-338
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211
Mailing Address - Country:US
Mailing Address - Phone:760-674-3355
Mailing Address - Fax:760-771-5149
Practice Address - Street 1:78-437 HWY 111
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253
Practice Address - Country:US
Practice Address - Phone:760-674-3355
Practice Address - Fax:760-771-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE-3589213E00000X
CAE3589213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty