Healthcare Provider Details

I. General information

NPI: 1578622502
Provider Name (Legal Business Name): SAN JUAN FOOT AND ANKLE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 E MAIN ST STE A
MONTROSE CO
81401-3848
US

IV. Provider business mailing address

PO BOX 21150
BOULDER CO
80308-4150
US

V. Phone/Fax

Practice location:
  • Phone: 970-240-3338
  • Fax: 970-240-1541
Mailing address:
  • Phone: 970-240-3338
  • Fax: 970-240-1541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number628
License Number StateCO

VIII. Authorized Official

Name: MR. CHRISTOPHER O COOK
Title or Position: PRESIDENT
Credential: DPM
Phone: 970-240-3338