Healthcare Provider Details
I. General information
NPI: 1518198696
Provider Name (Legal Business Name): ANIMAS FOOT AND ANKLE
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/06/2009
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
975 RIVERGATE UNIT 105
DURANGO CO
81301-7490
US
IV. Provider business mailing address
975 RIVERGATE UNIT 105
DURANGO CO
81301-7490
US
V. Phone/Fax
- Phone: 970-259-3154
- Fax: 970-259-9766
- Phone: 970-259-3154
- Fax: 970-259-9766
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 213ES0103X |
| Taxonomy | Foot & Ankle Surgery Podiatrist |
| License Number | 690 |
| License Number State | CO |
VIII. Authorized Official
Name: DR.
BEN
STUART
WEHRLI
Title or Position: PRESIDENT/PODIATRIST
Credential: DPM
Phone: 970-259-3154