Organization
ADVANCED FOOT CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY R CRUEL DPM (PODIATRIST OWNER)
(601) 981-3001
Entity
Organization
Contact information
Practice address
4510 OFFICE PARK DR, JACKSON, MS 39206-6016
(601) 981-3001
(601) 981-8999
Mailing address
4510 OFFICE PARK DR, JACKSON, MS 39206-6016
(601) 981-3001
(601) 981-8999
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
80152
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09274794
—
MS
Enumeration date
06/04/2007
Last updated
08/19/2008
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