=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699224550
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KYLE DURFEY DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2016
-----------------------------------------------------
Last Update Date | 06/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6170 S 51ST AVE STE 103
-----------------------------------------------------
City | LAVEEN
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-607-2700
-----------------------------------------------------
Fax | 602-607-2702
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6170 S 51ST AVE STE 103
-----------------------------------------------------
City | LAVEEN
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85339-6305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-607-2700
-----------------------------------------------------
Fax | 602-607-2702
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 000924
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------