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General NPI Number Information
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NPI Number | 1215321856
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Entity Type | Organization
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Legal Business Name | FOOT AND ANKLE SPECIALISTS OF COLORADO PLLC
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Dates
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Enumeration Date | 03/20/2015
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Last Update Date | 10/23/2019
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Provider Practice Location Address
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Address Line | 604 S 9TH ST
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City | CANON CITY
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State | CO
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Zip | 81212-4910
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Country | US
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Telephone | 719-275-1037
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 576
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City | CANON CITY
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State | CO
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Zip | 81215-0576
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Country | US
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Telephone | 719-275-1037
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Fax | 719-275-1305
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Authorized Official
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Title or Position | OWNER
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Name | MORGAN KIZZAR
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Credential |
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Telephone | 719-275-1037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | POD.0000747
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License Number State | CO
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