Provider Demographics
NPI:1487216982
Name:PHYSICIAN FOOT & ANKLE SERVICES PLLC
Entity type:Organization
Organization Name:PHYSICIAN FOOT & ANKLE SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:HALE
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:918-706-9875
Mailing Address - Street 1:2609 HIGHWOOD PL
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-4884
Mailing Address - Country:US
Mailing Address - Phone:918-384-9159
Mailing Address - Fax:
Practice Address - Street 1:2609 HIGHWOOD PL
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-4884
Practice Address - Country:US
Practice Address - Phone:918-384-9159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty