Healthcare Provider Details

I. General information

NPI: 1073049458
Provider Name (Legal Business Name): RILEY JOSEPH RAMPTON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N GATEWAY DR STE 801
PROVIDENCE UT
84332-9004
US

IV. Provider business mailing address

2301 INDIAN WELLS RD STE A
ALAMOGORDO NM
88310-4611
US

V. Phone/Fax

Practice location:
  • Phone: 435-787-1023
  • Fax: 435-787-1882
Mailing address:
  • Phone: 575-434-0639
  • Fax: 575-551-5007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPDT.0000563
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPDT.0000563
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD432
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number12160807-0501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: