Basic Information
| Provider Information | |||||||||
| NPI: | 1659610699 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOOT AND ANKLE CENTER PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19820 N 7TH ST | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850241689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804733668 | ||||||||
| FaxNumber: | 4804733668 | ||||||||
| Practice Location | |||||||||
| Address1: | 19820 N 7TH ST | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850241689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804733668 | ||||||||
| FaxNumber: | 4804733671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2013 | ||||||||
| LastUpdateDate: | 03/16/2017 | ||||||||
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| AuthorizedOfficialLastName: | CORY | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6024223822 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.