| NPI | 1871223149 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLE FOWELL Credentialing Manager 520-322-6274 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2022-06-10 |