Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Surgery, Foot & Ankle |
213ES0103X | 48 | Podiatry |
| NPI # | 1861809311 |
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| LBN Legal business name | ALASKAN LEGACY PODIATRIC FOOT & ANKLE SPECIALIST LLC | ||||
| Authorized official | ELISA LEAR-RAYBORN - (PHYSICIAN) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 07/16/2014 | ||||
| Last updated | 11/13/2014 - About 12 years ago | ||||
| Identifiers |
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