Healthcare Provider Details

I. General information

NPI: 1093221723
Provider Name (Legal Business Name): SQUIRE FOOT AND ANKLE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 S MAIN ST UNIT B203
SNOWFLAKE AZ
85937-5585
US

IV. Provider business mailing address

932 S MAIN ST UNIT B203
SNOWFLAKE AZ
85937-5585
US

V. Phone/Fax

Practice location:
  • Phone: 928-414-1280
  • Fax: 928-414-1280
Mailing address:
  • Phone: 928-457-0961
  • Fax: 928-457-0929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number875
License Number StateAZ

VIII. Authorized Official

Name: DR. CHAD A SQUIRE
Title or Position: OWNER/PARTNER
Credential: DPM
Phone: 928-457-0961