Healthcare Provider Details

I. General information

NPI: 1205973401
Provider Name (Legal Business Name): ALBUQUERQUE FOOT & ANKLE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6821 MONTGOMERY BLVD NE SUITE D
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

6821 MONTGOMERY BLVD NE SUITE D
ALBUQUERQUE NM
87109-1410
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-8081
  • Fax: 505-883-5997
Mailing address:
  • Phone: 505-881-8081
  • Fax: 505-883-5997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number291
License Number StateNM

VIII. Authorized Official

Name: DR. SHARON WALSTON KOBOS
Title or Position: PODIATRIST
Credential: DPM
Phone: 505-881-8081