Provider Demographics
NPI:1710001961
Name:SUN CITY FOOT CARE
Entity type:Organization
Organization Name:SUN CITY FOOT CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GUBLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:702-256-8454
Mailing Address - Street 1:3320 NORTH BUFFALO DRIVE
Mailing Address - Street 2:STE 107
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7410
Mailing Address - Country:US
Mailing Address - Phone:702-256-8454
Mailing Address - Fax:702-256-0387
Practice Address - Street 1:3320 NORTH BUFFALO DRIVE
Practice Address - Street 2:STE 107
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7410
Practice Address - Country:US
Practice Address - Phone:702-256-8454
Practice Address - Fax:702-256-0387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9804213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCC1573OtherBLUE CROSS BLUE SHIELD
NV1943324OtherUNITED HEALTH CARE
NV002102006Medicaid
NV480029166OtherRAILROAD MEDICARE
NV7208106OtherAETNA
NVU75741Medicare UPIN
NV1315050001Medicare NSC
NVV104596Medicare PIN