Organization
LAFAYETTE FOOT AND ANKLE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENNY FAIR JR. DPM (OWNER)
(260) 458-9953
Entity
Organization
Contact information
Practice address
2700 LAFAYETTE ST STE 230, FORT WAYNE, IN 46806-1100
(260) 458-9953
(260) 458-9238
Mailing address
2700 LAFAYETTE ST STE 230, FORT WAYNE, IN 46806-1100
(260) 458-9953
(260) 458-9238
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
07000728
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100082090A
—
IN
01
—
P00128864
RR MCR
—
Enumeration date
12/07/2007
Last updated
01/06/2025
Update your record
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