Healthcare Provider Details

I. General information

NPI: 1104123249
Provider Name (Legal Business Name): CASTLE ROCK FOOT & ANKLE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2352 MEADOWS BLVD STE 270
CASTLE ROCK CO
80109
US

IV. Provider business mailing address

PO BOX 639
CASTLE ROCK CO
80104-0639
US

V. Phone/Fax

Practice location:
  • Phone: 303-814-1082
  • Fax: 303-814-0020
Mailing address:
  • Phone: 303-814-1082
  • Fax: 303-814-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number686
License Number StateCO

VIII. Authorized Official

Name: DR. JESSICA HERZOG
Title or Position: PHYSICIAN
Credential: DPM
Phone: 303-814-1082