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General NPI Number Information
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NPI Number | 1265551378
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Entity Type | Organization
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Legal Business Name | PUT YOUR FEET FIRST, PC
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 05/12/2016
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Provider Practice Location Address
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Address Line | 10605 N HAYDEN RD G 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-5686
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Country | US
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Telephone | 480-423-8400
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Fax | 480-423-9773
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Provider Business Mailing Address
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Address Line | 10605 N HAYDEN RD G 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-5686
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Country | US
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Telephone | 480-423-8400
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Fax | 480-423-9773
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Authorized Official
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Title or Position | OWNER CEO
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Name | MARK D FORMAN
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Credential | DPM
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Telephone | 480-423-8400
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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 | AZ
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