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Organization

DR. DALE FAZIO FOOT CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DALE C FAZIO M.D (MD/OWNER)
(318) 797-3470
Entity
Organization

Contact information

Practice address
1914 E 70TH ST, SUITE D, SHREVEPORT, LA 71105-5312
(318) 797-3470
(318) 797-9956
Mailing address
1914 E 70TH ST, SUITE D, SHREVEPORT, LA 71105-5312
(318) 797-3470
(318) 797-9956

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PD009
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1318451
LA
Enumeration date
06/17/2008
Last updated
06/17/2008
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