Provider Demographics
NPI:1952923708
Name:FOOT DOC PLLC
Entity Type:Organization
Organization Name:FOOT DOC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-744-6234
Mailing Address - Street 1:955 N MCQUEEN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8129
Mailing Address - Country:US
Mailing Address - Phone:480-744-6234
Mailing Address - Fax:480-907-0500
Practice Address - Street 1:955 N MCQUEEN RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8129
Practice Address - Country:US
Practice Address - Phone:480-744-6234
Practice Address - Fax:480-907-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty