Healthcare Provider Details

I. General information

NPI: 1902976566
Provider Name (Legal Business Name): CHRISTOPHER OFFUTT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 MULLINS AVE
ALAMOSA CO
81101-4274
US

IV. Provider business mailing address

2415 MULLINS AVE
ALAMOSA CO
81101-4274
US

V. Phone/Fax

Practice location:
  • Phone: 719-587-0330
  • Fax: 719-587-0440
Mailing address:
  • Phone: 719-587-0330
  • Fax: 719-587-0440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberC50583
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00513
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: