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General NPI Number Information
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NPI Number | 1437563699
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Entity Type | Organization
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Legal Business Name | FOOT & ANKLE SPECIALISTS OF IDAHO, P.C.
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Dates
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Enumeration Date | 06/16/2014
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Last Update Date | 09/17/2014
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Provider Practice Location Address
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Address Line | 1277 E 17TH ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6126
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Country | US
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Telephone | 267-644-6880
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Fax |
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Provider Business Mailing Address
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Address Line | 1277 E 17TH ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6126
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Country | US
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Telephone | 208-346-7443
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Fax | 208-346-7442
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Authorized Official
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Title or Position | DOCTOR OF PODIATRIC MEDICINE
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Name | DR. JOHN D PETERSON
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Credential | DPM
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Telephone | 208-346-7443
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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 | P-223
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License Number State | ID
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