Healthcare Provider Details

I. General information

NPI: 1902070386
Provider Name (Legal Business Name): RED ROCK PODIATRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 N MILDRED RD STE 1
CORTEZ CO
81321-2212
US

IV. Provider business mailing address

1280 N MILDRED RD STE 1
CORTEZ CO
81321-2212
US

V. Phone/Fax

Practice location:
  • Phone: 970-565-8336
  • Fax: 970-565-3134
Mailing address:
  • Phone: 970-565-8336
  • Fax: 970-565-3134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number540
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number540
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number540
License Number StateCO

VIII. Authorized Official

Name: DR. TERRY R COOK
Title or Position: PHYSICIAN AND OWNER
Credential: D.P.M.
Phone: 970-565-8336