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General NPI Number Information
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NPI Number | 1003617853
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Entity Type | Organization
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Legal Business Name | EXTENSIVE FOOT AND ANKLE, PLLC
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 1951 W 25TH ST STE E
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City | YUMA
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State | AZ
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Zip | 85364-6924
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Country | US
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Telephone | 480-521-2180
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Fax |
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Provider Business Mailing Address
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Address Line | 1065 S TAMARACK AVE
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City | YUMA
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State | AZ
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Zip | 85364-4136
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MICHAEL GIFFORD
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Credential | DPM
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Telephone | 928-955-0777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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