Provider Demographics
NPI:1871898288
Name:ARIZONA FOOT AND ANKLE MEDICINE AND SURGERY, PLC
Entity type:Organization
Organization Name:ARIZONA FOOT AND ANKLE MEDICINE AND SURGERY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:480-699-8762
Mailing Address - Street 1:PO BOX 13385
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-3385
Mailing Address - Country:US
Mailing Address - Phone:480-609-9300
Mailing Address - Fax:480-609-9350
Practice Address - Street 1:1347 N GREENFIELD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4072
Practice Address - Country:US
Practice Address - Phone:480-699-8762
Practice Address - Fax:480-699-8350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0704213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ531450Medicaid
AZZ139561Medicare PIN
AZZ146113Medicare PIN
AZDU5379Medicare PIN