Healthcare Provider Details

I. General information

NPI: 1407026735
Provider Name (Legal Business Name): AFFILIATED PODIATRY ASSOC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 HARKLE RD STE C
SANTA FE NM
87505-4783
US

IV. Provider business mailing address

539 HARKLE RD STE C
SANTA FE NM
87505-4783
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 Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number124
License Number StateNM

VIII. Authorized Official

Name: MARC STESS
Title or Position: OWNER
Credential: DPN
Phone: 505-988-8863