Organization
ALTA RIDGE FOOT SPECIALISTS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT LLOYD VAN BREDERODE DPM (OWNER)
(828) 766-7667
Entity
Organization
Contact information
Practice address
537 ALTAPASS HWY, SPRUCE PINE, NC 28777-3012
(828) 766-7667
Mailing address
537 ALTAPASS HWY, SPRUCE PINE, NC 28777-3012
(828) 766-7667
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
479
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890809T
—
NC
Enumeration date
03/03/2009
Last updated
08/01/2012
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