Healthcare Provider Details

I. General information

NPI: 1356407027
Provider Name (Legal Business Name): HIGH DESERT FOOT & ANKLE SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9412 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87112-2878
US

IV. Provider business mailing address

PO BOX 53056
ALBUQUERQUE NM
87153-3056
US

V. Phone/Fax

Practice location:
  • Phone: 505-565-1155
  • Fax: 505-565-1166
Mailing address:
  • Phone: 505-565-1155
  • Fax: 505-565-1166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number279
License Number StateNM

VIII. Authorized Official

Name: DR. TOMMY GENE ROE
Title or Position: PHYSICIAN/OWNER
Credential: DPM
Phone: 505-565-1155