Provider Demographics
NPI:1386741478
Name:ADVANCED FOOT & ANKLE INC.
Entity type:Organization
Organization Name:ADVANCED FOOT & ANKLE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYAANDI
Authorized Official - Middle Name:RHONE
Authorized Official - Last Name:DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:702-696-9005
Mailing Address - Street 1:4275 BURNHAM AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5488
Mailing Address - Country:US
Mailing Address - Phone:702-696-9005
Mailing Address - Fax:702-696-9017
Practice Address - Street 1:4275 BURNHAM AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5488
Practice Address - Country:US
Practice Address - Phone:702-696-9005
Practice Address - Fax:702-696-9017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0602213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDN3532OtherRAILROAD MEDICARE PART B
NV5849640001Medicare NSC
NV102930Medicare PIN