Organization
FOOT DOCTOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRAVIS MARSHALL DPM (MANAGER)
(307) 359-9566
Entity
Organization
Contact information
Practice address
808 FREMONT ST, ASHTON, ID 83420-1210
(307) 359-9566
Mailing address
PO BOX 804, ASHTON, ID 83420-0804
(307) 359-9566
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
310400000X
Assisted Living Facility
—
—
314000000X
Skilled Nursing Facility
—
—
Other
Enumeration date
09/27/2023
Last updated
09/27/2023
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