Provider Demographics
NPI:1699344614
Name:ADVANCED FOOT AND ANKLE OF VIRGINIA PLLC
Entity type:Organization
Organization Name:ADVANCED FOOT AND ANKLE OF VIRGINIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZALES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:804-390-9879
Mailing Address - Street 1:1225 THE FRST
Mailing Address - Street 2:
Mailing Address - City:CROZIER
Mailing Address - State:VA
Mailing Address - Zip Code:23039-2421
Mailing Address - Country:US
Mailing Address - Phone:804-709-7141
Mailing Address - Fax:
Practice Address - Street 1:5231 HICKORY PARK DR STE D
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2619
Practice Address - Country:US
Practice Address - Phone:804-390-9879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty