Big Horn Foot Clinic, PC

Key facts

NPI

1003050253

Entity type

Organization (NPI type 2)

Primary specialty

Foot & Ankle Surgery Podiatrist 213ES0103X

License

104 (WY)

Legal business name

BIG HORN FOOT CLINIC, PC

Practice address

424 Yellowstone Ave
Suite 140
Cody, WY 82414-9318

Phone

(307) 527-9191

NPI assigned

Apr 30, 2009

Organization subpart

No

Authorized official

Name

Duncan Hugh Fraser, D.P.M.

Title

Podiatrist/Owner

Phone

(307) 527-9191

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lael J. Beachler, DPM Foot & Ankle Surgery Podiatrist · Powell, WY · NPI 1922241181
  NPD FOOT & ANKLE SURGERY

National Provider Directory

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 30, 2009.

{
    "created_epoch": "1241049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241049600000",
    "number": "1003050253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 AVENUE H",
            "city": "POWELL",
            "state": "WY",
            "postal_code": "824352260",
            "telephone_number": "307-754-9191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 YELLOWSTONE AVE",
            "address_2": "SUITE 140",
            "city": "CODY",
            "state": "WY",
            "postal_code": "824149318",
            "telephone_number": "307-527-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIG HORN FOOT CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-30",
        "last_updated": "2009-04-30",
        "status": "A",
        "authorized_official_last_name": "FRASER",
        "authorized_official_first_name": "DUNCAN",
        "authorized_official_middle_name": "HUGH",
        "authorized_official_title_or_position": "PODIATRIST/OWNER",
        "authorized_official_telephone_number": "307-527-9191",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "WY",
            "license": "104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC NPI FOR 777 AVENUE H POWELL, WY 82435",
            "identifier": "1245365154",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113976200",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR D HUGH FRASER DPM",
            "identifier": "1114923463",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "307844",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "480027493",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Cody, WY · Foot & Ankle Surgery Podiatrist in Wyoming