Healthcare Provider Details

I. General information

NPI: 1114396686
Provider Name (Legal Business Name): ELEVATION FOOT AND ANKLE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 E 28TH AVE
DENVER CO
80205-5025
US

IV. Provider business mailing address

3445 E 28TH AVE
DENVER CO
80205-5025
US

V. Phone/Fax

Practice location:
  • Phone: 303-388-0976
  • Fax: 303-388-0978
Mailing address:
  • Phone: 303-388-0976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0000743
License Number StateCO

VIII. Authorized Official

Name: RONNIE LEANN POLLARD
Title or Position: DPM
Credential:
Phone: 303-388-0976