Healthcare Provider Details

I. General information

NPI: 1750546859
Provider Name (Legal Business Name): DOUGLAS TOZZOLI, DPM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 HARKLE RD SUITE C
SANTA FE NM
87505-4782
US

IV. Provider business mailing address

539 HARKLE RD SUITE C
SANTA FE NM
87505-4782
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-8863
  • Fax: 505-988-5940
Mailing address:
  • Phone: 505-988-8863
  • Fax: 505-988-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number302
License Number StateNM

VIII. Authorized Official

Name: DOUGLAS ANTHONY TOZZOLI
Title or Position: PRESIDENT
Credential: DPM
Phone: 505-988-8863