Healthcare Provider Details

I. General information

NPI: 1093919631
Provider Name (Legal Business Name): BARRETT FOOT & ANKLE CENTER PHOENIX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9377 E BELL RD SUITE 131
SCOTTSDALE AZ
85260-1502
US

IV. Provider business mailing address

4131 DIRECTORS ROW PO BOX 925919
HOUSTON TX
77092-8703
US

V. Phone/Fax

Practice location:
  • Phone: 480-473-1901
  • Fax: 480-567-0292
Mailing address:
  • Phone: 713-586-6778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number0557
License Number StateAZ

VIII. Authorized Official

Name: MS. JO ANN JOHNSON
Title or Position: CREDENTIALING
Credential:
Phone: 713-586-6778