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General NPI Number Information
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NPI Number | 1891989760
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Entity Type | Organization
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Legal Business Name | BOULDER VALLEY FOOT & ANKLE CLINIC PC
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 4735 WALNUT ST STE C
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City | BOULDER
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State | CO
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Zip | 80301-2553
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Country | US
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Telephone | 303-443-8900
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Fax | 303-442-3140
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Provider Business Mailing Address
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Address Line | 4735 WALNUT ST STE C
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City | BOULDER
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State | CO
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Zip | 80301-2553
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Country | US
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Telephone | 303-443-8900
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Fax | 303-442-3140
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Authorized Official
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Title or Position | MANAGER
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Name | DONNA J COURTEMANCHE
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Credential |
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Telephone | 303-443-8900
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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 |
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 478
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License Number State | CO
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