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General NPI Number Information
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NPI Number | 1801209499
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Entity Type | Organization
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Legal Business Name | FOUR CORNERS FOOT AND ANKLE P.C.
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Dates
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Enumeration Date | 06/11/2014
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 2700 FARMINGTON AVE BLDG C STE 1
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City | FARMINGTON
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State | NM
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Zip | 87401-4550
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Country | US
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Telephone | 505-327-4044
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Fax | 970-259-3510
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Provider Business Mailing Address
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Address Line | 1266 ESCALANTE DR SUITE 201
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City | DURANGO
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State | CO
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Zip | 81301
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Country | US
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Telephone | 970-259-5303
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Fax | 970-259-3510
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Authorized Official
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Title or Position | OWNER
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Name | DR. KAYSE L LAKE
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Credential | DPM
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Telephone | 970-259-5303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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