Provider Demographics
NPI:1205345485
Name:FOOT DOCTOR, PLLC
Entity type:Organization
Organization Name:FOOT DOCTOR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:SHAUN
Authorized Official - Last Name:LUND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:662-234-3668
Mailing Address - Street 1:1735 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-4109
Mailing Address - Country:US
Mailing Address - Phone:662-234-3668
Mailing Address - Fax:662-281-0002
Practice Address - Street 1:1194 S 18TH STREET EXT
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5378
Practice Address - Country:US
Practice Address - Phone:662-281-3668
Practice Address - Fax:662-281-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80222213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty