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General NPI Number Information
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NPI Number | 1841469012
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Entity Type | Organization
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Legal Business Name | SALLY A SERVOLD DPM PC
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 401 23RD ST SUITE 205
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601-4363
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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 | 401 23RD ST SUITE 205
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601-4363
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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 | PRESIDENT
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Name | DR. SALLY A SERVOLD
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Credential | DPM
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Telephone | 970-928-9785
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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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