Provider Demographics
NPI:1336160548
Name:SONORAN FOOT SPECIALISTS, PLLC
Entity type:Organization
Organization Name:SONORAN FOOT SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIC SURGEON MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RICHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:480-629-5903
Mailing Address - Street 1:9767 N 91ST ST
Mailing Address - Street 2:STE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5086
Mailing Address - Country:US
Mailing Address - Phone:480-629-5903
Mailing Address - Fax:480-629-8498
Practice Address - Street 1:9767 N 91ST ST
Practice Address - Street 2:STE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5086
Practice Address - Country:US
Practice Address - Phone:480-629-5903
Practice Address - Fax:480-629-8498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0544213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7542669OtherAETNA
AZ7542669OtherAETNA
AZ5374170001Medicare NSC
AZDD9298Medicare PIN