MEDICARE: SUN VALLEY FOOT AND ANKLE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1023520947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN VALLEY FOOT AND ANKLE PLLC

Provider Business Mailing Address
First Line	:	PO BOX 7096
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95267-0096
Country	:	US
Telephone Number	:	209-956-7725
Fax Number	:	209-956-7733

Provider Business Practice Location Address
First Line	:	3336 E CHANDLER HEIGHTS RD STE 121
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85298-4263
Country	:	US
Telephone Number	:	480-245-7027
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT CHRISTOPHER ANDERSEN
Credential	:	DPM
Telephone Number	:	480-840-3457

Provider Enumeration Date	:	11/01/2017
Last Update Date	:	04/18/2018

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