MEDICARE: FOOT ANKLE ASSOCIATED OF THE DESERT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		CA
2	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1093795320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT ANKLE ASSOCIATED OF THE DESERT

Provider Business Mailing Address
First Line	:	82013 DR CARREON BLVD
Second Line	:
City	:	INDIO
State	:	CA
Zip	:	92201-5832
Country	:	US
Telephone Number	:	760-863-0048
Fax Number	:

Provider Business Practice Location Address
First Line	:	82013 DR CARREON BLVD
Second Line	:
City	:	INDIO
State	:	CA
Zip	:	92201-5832
Country	:	US
Telephone Number	:	760-863-0048
Fax Number	:

Authorized Official
Title or Position	:	PODIATRY
Name	:	MR. JOHN EDWARD EBAUGH
Credential	:	DPM
Telephone Number	:	760-863-0070

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	09/11/2025

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