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General NPI Number Information
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NPI Number | 1811180615
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Entity Type | Organization
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Legal Business Name | CANYON FOOT & ANKLE SPECIALISTS PC
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 676 SHOUP AVE W SUITE 12
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City | TWIN FALLS
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State | ID
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Zip | 83301-4615
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Country | US
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Telephone | 208-733-0436
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Fax | 208-733-0438
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Provider Business Mailing Address
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Address Line | PO BOX 5577
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City | TWIN FALLS
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State | ID
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Zip | 83303
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Country | US
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Telephone | 208-733-0436
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Fax | 208-733-0438
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Authorized Official
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Title or Position | OWNER
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Name | DR. CORY PILLING
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Credential | DO
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Telephone | 208-733-0436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | P-187
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License Number State | ID
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