| NPI | 1154995694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN ALLAN WEBB Owner 801-400-2269 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2021-10-20 |