Organization
REGIONAL FOOT AND ANKLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATT CLAYTON GARRISON D.P.M. (CO-OWNER)
(417) 326-6200
Entity
Organization
Contact information
Practice address
785 E DRAKE ST, BOLIVAR, MO 65613-2739
(417) 326-6200
(417) 777-7463
Mailing address
785 E DRAKE ST, BOLIVAR, MO 65613-2739
(417) 326-6200
(417) 777-7463
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
2005017337
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
307420505
—
MO
Enumeration date
08/01/2008
Last updated
09/24/2009
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