Organization
FOOT CENTERS OF NC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN ANDREW PETERY DPM (PRESIDENT)
(336) 218-8490
Entity
Organization
Contact information
Practice address
3303 HEALY DR STE B, WINSTON SALEM, NC 27103-1569
(336) 768-8848
(336) 768-3078
Mailing address
76764 LANCELOT CT, PALM DESERT, CA 92211-7103
(760) 408-5053
(760) 345-3609
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
297
NC
213ES0103X
Foot & Ankle Surgery Podiatrist
297
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
690193J
—
NC
01
—
CK4958
MEDICARE PTAN RAILROAD
NC
Enumeration date
10/02/2006
Last updated
02/19/2019
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