Healthcare Provider Details

I. General information

NPI: 1508116427
Provider Name (Legal Business Name): COMMUNITY FOOT AND ANKLE CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9351 GRANT ST SUITE 490
THORNTON CO
80229-4358
US

IV. Provider business mailing address

9351 GRANT STREET SUITE 490
THORNTON CO
80229-4358
US

V. Phone/Fax

Practice location:
  • Phone: 303-451-5271
  • Fax: 303-452-4398
Mailing address:
  • Phone: 303-451-5271
  • Fax: 303-452-4398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00307
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00520
License Number StateCO

VIII. Authorized Official

Name: DR. JAMES D DAVIS
Title or Position: OWNER
Credential: DPM
Phone: 303-451-5271