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Organization
ABOITE PODIATRY ASSOCIATES PC
Active
Organization
ABOITE PODIATRY ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYNN H STAFFORD DPM (PRESIDENT)
(260) 436-3579
Entity
Organization
Contact information
Practice address
7559 WEST JEFFERSON BLVD, FORT WAYNE, IN 46804-4131
(260) 436-3579
(260) 459-0287
Mailing address
7559 WEST JEFFERSON BLVD, FORT WAYNE, IN 46804-4131
(260) 436-3579
(260) 459-0287
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
07000636A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000103321
ANTHEM GROUP ID NUMBER
IN
Enumeration date
05/03/2007
Last updated
10/08/2012
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