NPI | 1033111240 |
---|---|
Doing Business As | SOUTHSIDE FOOT CLINIC |
Entity Type | Organization |
Authorized Contact | RICHARD TAYLOR HAVENS Physician/Administrator 318-687-6266 |
Organization Subpart ? | No |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: LA 5B496) |
Enumeration Date | 2005-06-01 |
Last Update Date | 2023-06-08 |