Provider Demographics
NPI:1336234236
Name:PERRY REGIONAL FOOT & ANKLE, PSC
Entity Type:Organization
Organization Name:PERRY REGIONAL FOOT & ANKLE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROTHRAUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:812-547-7482
Mailing Address - Street 1:620 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-1704
Mailing Address - Country:US
Mailing Address - Phone:812-547-7482
Mailing Address - Fax:812-547-7482
Practice Address - Street 1:620 MAIN ST
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-1704
Practice Address - Country:US
Practice Address - Phone:812-547-7482
Practice Address - Fax:812-547-7482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000753213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200141070AMedicaid
IN251470Medicare PIN
IN200141070AMedicaid