Healthcare Provider Details

I. General information

NPI: 1639398183
Provider Name (Legal Business Name): DESERT FOOT & ANKLE P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 S DOBSON RD SUITE 312
MESA AZ
85202-4700
US

IV. Provider business mailing address

PO BOX 32611
BELFAST ME
04915-0219
US

V. Phone/Fax

Practice location:
  • Phone: 480-844-8218
  • Fax: 480-844-9950
Mailing address:
  • Phone: 480-844-8218
  • Fax: 480-844-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER REYZELMAN
Title or Position: RCMO
Credential: DPM
Phone: 415-292-0638