Healthcare Provider Details

I. General information

NPI: 1730220005
Provider Name (Legal Business Name): SAN JUAN FOOT AND ANKLE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 COTTONWOOD ST
DELTA CO
81416-4400
US

IV. Provider business mailing address

PO BOX 21150
BOULDER CO
80308-4150
US

V. Phone/Fax

Practice location:
  • Phone: 970-240-3338
  • Fax: 970-240-1541
Mailing address:
  • Phone: 970-240-3338
  • Fax: 970-240-1541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number628
License Number StateCO

VIII. Authorized Official

Name: CHRISTOPHER OTTO COOK
Title or Position: DOCTOR OF PODIATRIC MEDICINE
Credential: D.P.M.
Phone: 970-240-3338