Provider Demographics
NPI:1881718963
Name:EAGLE FOOT & ANKLE SPECIALISTS, LLC
Entity type:Organization
Organization Name:EAGLE FOOT & ANKLE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GIDEON
Authorized Official - Middle Name:S
Authorized Official - Last Name:BURIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-458-0752
Mailing Address - Street 1:PO BOX 1091
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-0020
Mailing Address - Country:US
Mailing Address - Phone:610-458-0752
Mailing Address - Fax:610-524-0133
Practice Address - Street 1:855 SPRINGDALE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2852
Practice Address - Country:US
Practice Address - Phone:610-458-0752
Practice Address - Fax:610-524-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004423L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1992742704OtherINDIVIDUAL NPI NUMBER