Healthcare Provider Details

I. General information

NPI: 1346354354
Provider Name (Legal Business Name): SOLE FOOT AND ANKLE SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 W THUNDERBIRD RD STE G700
GLENDALE AZ
85306-4673
US

IV. Provider business mailing address

PO BOX 27514
TEMPE AZ
85285-7514
US

V. Phone/Fax

Practice location:
  • Phone: 602-938-3600
  • Fax: 602-938-0400
Mailing address:
  • Phone: 480-967-6500
  • Fax: 480-967-6540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JAY C LARSON
Title or Position: OWNER/PRESIDENT
Credential: DPM
Phone: 602-938-3600