Organization
ADVANCED FOOT CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FARZAD FARYABI DPM (OWNER)
(601) 936-3445
Entity
Organization
Contact information
Practice address
2475 LAKELAND DR, SUITE B, FLOWOOD, MS 39232-9505
(601) 936-3445
(601) 936-7434
Mailing address
2475 LAKELAND DR, SUITE B, FLOWOOD, MS 39232-9505
(601) 936-3445
(601) 936-7434
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
80147
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00120443
—
MS
01
—
427495756
BLUE CROSS BLUE SHIELD
MS
Enumeration date
02/12/2008
Last updated
12/26/2013
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