Dr. Dale Fazio Foot Clinic

Primary specialty

PodiatristTaxonomy code 213E00000X

License

PD009 Issued in LA

Legal business name

DR. DALE FAZIO FOOT CLINIC

Practice address

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

Phone

(318) 797-3470

Fax

(318) 797-9956

NPI assigned

Jun 17, 2008

Last updated

Jun 17, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Dale C Fazio, M.DNPI 1194723577

Title

MD/Owner

Phone

(318) 797-3470

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dale Carlton Fazio, D.P.M.

  • Podiatrist
  • Shreveport, LA
  • NPI 1194723577
  NPD (past) Authorized official

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

{
    "created_epoch": "1213660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1265692859",
    "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": {
        "organization_name": "DR. DALE FAZIO FOOT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-17",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "FAZIO",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "318-797-3470",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "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": []
}

• Evan Downs, MD
• Samantha Doyal, PHARM.D
• Connor Alexander Doyle, MD
• Sharon Lynn Doyle, LMSW
• DP Wyatt LLC
• Dr. James P Floyd LLC
• Dr. Laurence E Welker, Apmc (Laurence E Welker, DPM)
• Dr. Monica a. Davenport, DDS Apc (Davenport Family Dental)
• Dr. Rudolph W. Troup, P.C.
• Dr. Sesha K. Sataluri, MD, LLC

• Podiatrist in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Podiatrist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.