Healthcare Provider Details

I. General information

NPI: 1588842124
Provider Name (Legal Business Name): COMPLETE FOOT CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2037 JERRY MURPHY RD STE 100
PUEBLO CO
81001-1256
US

IV. Provider business mailing address

2037 JERRY MURPHY RD STE 100
PUEBLO CO
81001-1256
US

V. Phone/Fax

Practice location:
  • Phone: 719-544-5958
  • Fax: 719-544-5991
Mailing address:
  • Phone: 719-544-5958
  • Fax: 719-544-5991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number595
License Number StateCO

VIII. Authorized Official

Name: DR. ERIC J. RICHARDSON
Title or Position: DOCTOR/OWNER
Credential: D.P.M.
Phone: 719-544-5958