| Organization Name: | RIVER CITY FOOT AND ANKLE PLLC |
| NPI Number: | 1043411952 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RODNEY ALLAN GRAVES (MANAGER) |
| Mailing Address: | 925 Stevens Dr Ste 1b Richland |
| State: | WA US |
| Postal Code: | 993523523 |
| Phone Number: | 5099432325 |
| Fax Number: | 5099433021 |
| NPI Enumeration Date: | 05/29/2007 |
| NPI Last Update Date: | 02/01/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | PO00000758 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |