Healthcare Provider Details

I. General information

NPI: 1205017654
Provider Name (Legal Business Name): NORTHERN NEVADA FOOT & ANKLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 BROWNING WAY STE 101
ELKO NV
89801-8338
US

IV. Provider business mailing address

1775 BROWNING WAY STE 101
ELKO NV
89801-8338
US

V. Phone/Fax

Practice location:
  • Phone: 775-753-4044
  • Fax:
Mailing address:
  • Phone: 775-753-4044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberNV9506
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberNV9506
License Number StateNV

VIII. Authorized Official

Name: DR. JOHN P PATTON
Title or Position: OWNER
Credential: M.D.
Phone: 775-753-4044