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General NPI Number Information
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NPI Number | 1225194608
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Entity Type | Organization
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Legal Business Name | RIO GRANDE FOOT CLINIC INC
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 710 S ALAMEDA BLVD
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City | LAS CRUCES
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State | NM
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Zip | 88005-2928
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Country | US
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Telephone | 575-523-8566
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Fax | 575-525-2065
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Provider Business Mailing Address
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Address Line | 710 S ALAMEDA BLVD
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City | LAS CRUCES
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State | NM
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Zip | 88005-2928
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Country | US
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Telephone | 575-523-8566
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Fax | 575-525-2065
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID L DEETZ
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Credential | D.P.M.
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Telephone | 575-523-8566
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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 | NM142
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License Number State | NM
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