Provider Demographics
NPI:1912055336
Name:PREMIER FOOT SPECIALISTS, LLC
Entity type:Organization
Organization Name:PREMIER FOOT SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:504-241-5707
Mailing Address - Street 1:7311 DOWNMAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-1213
Mailing Address - Country:US
Mailing Address - Phone:504-241-5707
Mailing Address - Fax:504-241-1945
Practice Address - Street 1:7311 DOWNMAN RD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-1213
Practice Address - Country:US
Practice Address - Phone:504-241-5707
Practice Address - Fax:504-241-1945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD088R213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA139724Medicaid
LA4229310001Medicare NSC
T91229Medicare UPIN
LA139724Medicaid
4229310001Medicare NSC
LA5C346Medicare PIN