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General NPI Number Information
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NPI Number | 1932343639
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Entity Type | Organization
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Legal Business Name | FOOT AND ANKLE CLINIC
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Dates
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Enumeration Date | 04/24/2009
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Last Update Date | 04/24/2009
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Provider Practice Location Address
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Address Line | 1885 W 4400 S
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City | ROY
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State | UT
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Zip | 84067-3065
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Country | US
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Telephone | 801-731-3833
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Fax | 801-731-4561
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Provider Business Mailing Address
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Address Line | 1885 W 4400 S
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City | ROY
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State | UT
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Zip | 84067-3065
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Country | US
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Telephone | 801-731-3833
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Fax | 801-731-4561
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS R. AUSTAD
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Credential | D.P.M
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Telephone | 801-731-3833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 102623-0501
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License Number State | UT
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