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General NPI Number Information
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NPI Number | 1750938478
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Entity Type | Organization
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Legal Business Name | RIO GRANDE FOOT & ANKLE SPECIALISTS LLC
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Dates
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Enumeration Date | 08/19/2019
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 1399 WEIMER RD STE 400
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City | TAOS
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State | NM
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Zip | 87571-6348
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Country | US
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Telephone | 575-214-8521
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Fax | 877-540-1253
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Provider Business Mailing Address
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Address Line | 280 S MAIN ST
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City | BOUNTIFUL
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State | UT
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Zip | 84010-6236
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Country | US
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Telephone | 801-505-0821
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Fax | 801-505-0803
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS & CREDENTIAL
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Name | SUSAN MARIE TAYLOR
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Credential |
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Telephone | 801-505-0821
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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 |
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