Healthcare Provider Details

I. General information

NPI: 1871083766
Provider Name (Legal Business Name): FLIPPIN FOOT AND ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9255 W ALAMEDA AVE STE F
LAKEWOOD CO
80226-2802
US

IV. Provider business mailing address

9255 W ALAMEDA AVE STE F
LAKEWOOD CO
80226-2802
US

V. Phone/Fax

Practice location:
  • Phone: 303-233-9107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0000817
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0000820
License Number StateCO

VIII. Authorized Official

Name: MITCHELL FLIPPIN
Title or Position: CO-OWNER
Credential: DPM
Phone: 303-233-9107