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Organization
LAS VEGAS FOOT SPECIALIST, INC
Active
Organization
LAS VEGAS FOOT SPECIALIST, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE A ANDERSEN DPM (PRESIDENT)
(505) 425-9491
Entity
Organization
Contact information
Practice address
109 RAILROAD AVE, LAS VEGAS, NM 87701-3853
(505) 425-9491
(505) 454-8171
Mailing address
109 RAILROAD AVE, LAS VEGAS, NM 87701-3853
(505) 425-9491
(505) 454-8171
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
163
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10478
PHP
NM
01
—
5351
BC/BS
NM
05
—
Q2055
—
NM
Enumeration date
08/04/2006
Last updated
05/07/2008
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