Provider Demographics
NPI:1427562719
Name:CORAL DESERT FOOT & ANKLE PC
Entity type:Organization
Organization Name:CORAL DESERT FOOT & ANKLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DPM
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-634-9225
Mailing Address - Street 1:1062 E RIVERSIDE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4454
Mailing Address - Country:US
Mailing Address - Phone:435-634-9225
Mailing Address - Fax:
Practice Address - Street 1:355 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KANAB
Practice Address - State:UT
Practice Address - Zip Code:84741-3260
Practice Address - Country:US
Practice Address - Phone:435-634-9225
Practice Address - Fax:435-634-8426
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORAL DESERT FOOT & ANKLE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-22
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty