Healthcare Provider Details

I. General information

NPI: 1124112180
Provider Name (Legal Business Name): ARIZONA FOOT HEALTH, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11209 N TATUM BLVD STE B100
PHOENIX AZ
85028-3091
US

IV. Provider business mailing address

11209 N TATUM BLVD STE B100
PHOENIX AZ
85028-3091
US

V. Phone/Fax

Practice location:
  • Phone: 602-973-3888
  • Fax: 602-973-3028
Mailing address:
  • Phone: 602-973-3888
  • Fax: 602-973-3028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. RYAN B GOLUB
Title or Position: OWNER
Credential:
Phone: 602-402-0421