Provider Demographics
NPI:1992090476
Name:DESERT SPORTS FOOT AND ANKLE LLC
Entity type:Organization
Organization Name:DESERT SPORTS FOOT AND ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-557-6802
Mailing Address - Street 1:PO BOX 5579
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85385-5579
Mailing Address - Country:US
Mailing Address - Phone:888-557-6802
Mailing Address - Fax:
Practice Address - Street 1:9431 W THUNDERBIRD RD STE 3
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4237
Practice Address - Country:US
Practice Address - Phone:888-557-6802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Multi-Specialty