Healthcare Provider Details

I. General information

NPI: 1629416342
Provider Name (Legal Business Name): FOUR CORNERS FOOT AND ANKLE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 ESCALANTE DR SUITE 201
DURANGO CO
81301-7490
US

IV. Provider business mailing address

1266 ESCALANTE DR SUITE 201
DURANGO CO
81301-7490
US

V. Phone/Fax

Practice location:
  • Phone: 970-259-5303
  • Fax: 970-259-3510
Mailing address:
  • Phone: 970-259-5303
  • Fax: 970-259-3510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPOD710
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. KAYSE L LAKE
Title or Position: OWNER
Credential: DPM
Phone: 970-259-5303