Healthcare Provider Details

I. General information

NPI: 1699337741
Provider Name (Legal Business Name): SOUTHWEST FOOT AND ANKLE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 09/27/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 E 8TH AVE STE N-102
DURANGO CO
81301-5708
US

IV. Provider business mailing address

270 E 8TH AVE STE N-102
DURANGO CO
81301-5708
US

V. Phone/Fax

Practice location:
  • Phone: 970-903-9853
  • Fax: 970-616-6745
Mailing address:
  • Phone: 970-903-9853
  • Fax: 970-616-6745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS HUGENTOBLER
Title or Position: DPM/OWNER
Credential: DPM
Phone: 970-903-9853