Healthcare Provider Details

I. General information

NPI: 1356694228
Provider Name (Legal Business Name): GROTH FOOT & ANKLE CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 N UNION BLVD STE 320
COLORADO SPGS CO
80907-4916
US

IV. Provider business mailing address

3920 N UNION BLVD STE 320
COLORADO SPGS CO
80907-4916
US

V. Phone/Fax

Practice location:
  • Phone: 719-574-2000
  • Fax: 719-574-6477
Mailing address:
  • Phone: 719-574-2000
  • Fax: 719-574-6477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRYAN ALAN GROTH
Title or Position: OWNER
Credential: DPM
Phone: 719-574-2000