Provider Demographics
NPI:1104123249
Name:CASTLE ROCK FOOT & ANKLE CARE PC
Entity type:Organization
Organization Name:CASTLE ROCK FOOT & ANKLE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERZOG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:303-814-1082
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-0639
Mailing Address - Country:US
Mailing Address - Phone:303-814-1082
Mailing Address - Fax:303-814-0080
Practice Address - Street 1:2352 MEADOWS BLVD STE 270
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109
Practice Address - Country:US
Practice Address - Phone:303-814-1082
Practice Address - Fax:303-814-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO686213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000150592Medicaid