Organization
DERA, INC
Active
Other names
FOOT SOLUTIONS-FT WAYNE
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS REX BRUICK C.PED. (OWNER)
(260) 484-8966
Entity
Organization
Contact information
Practice address
513 E COLISEUM BLVD, FORT WAYNE, IN 46805-1215
(260) 484-8966
(260) 484-0508
Mailing address
513 E COLISEUM BLVD, FORT WAYNE, IN 46805-1215
(260) 484-8966
(260) 484-0508
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/29/2006
Last updated
04/13/2012
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