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Organization
ADVANCED FOOT & ANKLE CENTER, LLC
Active
Organization
ADVANCED FOOT & ANKLE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS STANLEY WILLIAMS D.P.M. (MANAGING MEMBER)
(208) 785-6700
Entity
Organization
Contact information
Practice address
9 AIRPORT RD, BLACKFOOT, ID 83221-1702
(208) 785-6700
(208) 785-6767
Mailing address
9 AIRPORT RD, BLACKFOOT, ID 83221-1702
(208) 785-6700
(208) 785-6767
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
P156
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015672
BLUE SHIELD
ID
01
—
341488
DMBA
ID
01
—
461973001
DMERC
ID
01
—
480034721
MEDICARE RAILROAD
ID
05
—
804309300
—
ID
01
—
P1571
BLUE CROSS
ID
Enumeration date
07/26/2010
Last updated
08/06/2021
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