Healthcare Provider Details

I. General information

NPI: 1104739119
Provider Name (Legal Business Name): FOOT AND ANKLE CENTER OF THE ROCKIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 CLEVELAND AVE
CHEYENNE WY
82001-6700
US

IV. Provider business mailing address

PO BOX 844327
LOS ANGELES CA
90084-4327
US

V. Phone/Fax

Practice location:
  • Phone: 307-632-1657
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: ANNA K WEBER
Title or Position: CMO
Credential:
Phone: 303-321-4477