Organization
ALTA RIDGE FOOT SPECIALISTS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT LLOYD VAN BREDERODE DPM (OWNER)
(828) 680-1161
Entity
Organization
Contact information
Practice address
105 CHESTNUT ST, MARS HILL, NC 28754-9602
(828) 680-1161
Mailing address
537 ALTAPASS HWY, SPRUCE PINE, NC 28777-3001
(828) 766-7667
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
479
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890809T
—
NC
Enumeration date
03/13/2012
Last updated
03/13/2012
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