Dale Carlton Fazio, D.P.M.

Primary specialty

PodiatristTaxonomy code 213E00000X

License

PD009 Issued in LA

Practice address

1914 E 70TH St
Suite D
Shreveport, LA 71105-5312

Phone

(318) 797-3470

Fax

(318) 797-9956

NPI assigned

Jul 11, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dr. Dale Fazio Foot Clinic

  • Podiatrist
  • Shreveport, LA
  • NPI 1265692859
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194723577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1914 E 70TH ST",
            "address_2": "SUITE D",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055312",
            "telephone_number": "318-797-3470",
            "fax_number": "318-797-9956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1914 E 70TH ST",
            "address_2": "SUITE D",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055312",
            "telephone_number": "318-797-3470",
            "fax_number": "318-797-9956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAZIO",
        "first_name": "DALE",
        "middle_name": "CARLTON",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "LA",
            "license": "PD009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1318451",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Qandeel Fatima
• Shannon Renee Faulkinberry, MD, MPH
• Darrell Favis Jr.
• Maheen Fawad, MD
• Tajammul N Fazili, MD
• Joyce Elizabeth Feagin, MD
• Alison Lanette Feaster
• Lee Arthur Feaster Jr.
• Rachael Feaster, LMSW
• Michael O. Feavel, D.D.S.

• All providers in Shreveport, LA
• Podiatrist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.