Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | PO1546 | FL |
N | 222Z00000X | Podiatrist | PO1546 | FL |
N | 213EP1101X | Primary Podiatric Medicine | PO1546 | FL |
N | 2081S0010X | Sports Medicine | PO1546 | FL |
N | 213ES0000X | Sports Medicine | PO1546 | FL |
Y | 213ES0103X | Foot & Ankle Surgery | PO1546 | FL |
NPI | 1457383341 |
---|---|
Provider Name | Alan W Streigold |
First Address | Gallup, NM 87305-1337 |
Second Address | Gallup, NM 87301-1337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 10/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
340472200 | (05) | FL |
5323800001 | DEMARC NUMBER (01) | FL |
T85795 | (02) | FL |