Organization
GLENWOOD AVENUE FOOT AND ANKLE PLLC
Active
Organization
GLENWOOD AVENUE FOOT AND ANKLE PLLC
Active
Other names
Bruce G Fawcett DPM
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE G FAWCETT DPM (SOLE OWNER)
(919) 829-0076
Entity
Organization
Contact information
Practice address
1514 GLENWOOD AVE, RALEIGH, NC 27608-2368
(919) 829-0076
(919) 836-9094
Mailing address
1514 GLENWOOD AVE, RALEIGH, NC 27608-2368
(919) 829-0076
(919) 836-9094
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
154
NC
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7908064
—
NC
Enumeration date
04/17/2008
Last updated
11/04/2016
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