Healthcare Provider Details

I. General information

NPI: 1013195924
Provider Name (Legal Business Name): FOOT SPECIALIST ASSOCIATES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 S BROADWAY
ENGLEWOOD CO
80113-4695
US

IV. Provider business mailing address

4055 S BROADWAY # 300
ENGLEWOOD CO
80113-4695
US

V. Phone/Fax

Practice location:
  • Phone: 303-722-6864
  • Fax: 303-722-5113
Mailing address:
  • Phone: 303-722-6864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00402
License Number StateCO

VIII. Authorized Official

Name: MRS. PEGGY J. DAUGHERTY
Title or Position: OFFICE MGR.
Credential:
Phone: 303-722-6864