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General NPI Number Information
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NPI Number | 1831281708
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Entity Type | Individual
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Provider Name | SALLY A SERVOLD DPM
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Gender | Female
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 820 CASTLE VALLEY BLVD SUITE 210
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City | NEW CASTLE
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State | CO
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Zip | 81647-9480
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Country | US
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Telephone | 970-928-9785
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Fax | 970-928-0423
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Provider Business Mailing Address
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Address Line | 820 CASTLE VALLEY BLVD SUITE 210
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City | NEW CASTLE
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State | CO
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Zip | 81647-9480
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Country | US
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Telephone | 970-928-9785
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Fax | 970-928-0423
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 0459
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License Number State | CO
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