Healthcare Provider Details

I. General information

NPI: 1205483765
Provider Name (Legal Business Name): PREMIER FOOT & ANKLE SURGEONS OF IOWA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 SW BROOKSIDE DR STE 200
GRIMES IA
50111-5244
US

IV. Provider business mailing address

255 SW BROOKSIDE DR STE 200
GRIMES IA
50111-5244
US

V. Phone/Fax

Practice location:
  • Phone: 515-500-6568
  • Fax: 515-393-6171
Mailing address:
  • Phone: 515-500-6568
  • Fax: 515-393-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DREW DAVIDSON
Title or Position: OWNER / SOLE MANAGING MEMBER
Credential: DPM
Phone: 515-500-6568