Provider Demographics
NPI:1386769784
Name:AP FOOT AND ANKLE SPECIALISTS PC
Entity type:Organization
Organization Name:AP FOOT AND ANKLE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARLIN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:719-544-5958
Mailing Address - Street 1:PO BOX 3026
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-0026
Mailing Address - Country:US
Mailing Address - Phone:719-544-5958
Mailing Address - Fax:719-544-5991
Practice Address - Street 1:509 COLORADO AVE
Practice Address - Street 2:SUITE D
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2008
Practice Address - Country:US
Practice Address - Phone:719-544-5958
Practice Address - Fax:719-544-5991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO648213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19907541Medicaid
DD7813OtherRAILROAD
COV00768Medicare UPIN
CO19907541Medicaid
COC801690Medicare PIN
DD7813OtherRAILROAD