Healthcare Provider Details

I. General information

NPI: 1457571127
Provider Name (Legal Business Name): ANDERSON PODIATRY CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 RIVERSIDE AVE SUITE C
FORT COLLINS CO
80524-4368
US

IV. Provider business mailing address

1355 RIVERSIDE AVE SUITE C
FORT COLLINS CO
80524-4368
US

V. Phone/Fax

Practice location:
  • Phone: 970-484-4620
  • Fax:
Mailing address:
  • Phone: 970-484-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number662
License Number StateCO

VIII. Authorized Official

Name: DR. JAMES CHARLES ANDERSON
Title or Position: OWNER
Credential: DPM
Phone: 970-484-4620