Organization
DPMSTRALEYPRVA,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RHONDA RICHARDSON (OFFICE MANAGER)
(757) 873-2101
Entity
Organization
Contact information
Practice address
705 MOBJACK PL, SUITE B, NEWPORT NEWS, VA 23606-1966
(757) 873-2101
Mailing address
705 MOBJACK PL, SUITE B, NEWPORT NEWS, VA 23606-1966
(757) 873-2101
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
0103300928
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010221862
—
VA
01
—
185871
ANTHEM BLUE CROSS BLUE SH
VA
Enumeration date
07/10/2007
Last updated
10/28/2009
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