Organization
EASTOVER FOOT & ANKLE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD VICTOR FUTERMAN DPM (PRESIDENT)
(704) 841-4000
Entity
Organization
Contact information
Practice address
428 N. TRADE STREET, SUITE 100, MATTHEWS, NC 28105-5017
(704) 841-4000
(704) 841-4338
Mailing address
PO BOX 1539, MATTHEWS, NC 28106-1539
(704) 841-4000
(704) 841-4338
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
200001392347
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0172M
BLUE CROSS BLUE SHIELD NC
NC
05
—
890172M
—
NC
Enumeration date
10/11/2006
Last updated
10/02/2015
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