Organization
EAST VALLEY FOOTCARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES CONNELL DPM (PRESIDENT)
(480) 357-4400
Entity
Organization
Contact information
Practice address
6104 E BROWN RD, SUITE 102, MESA, AZ 85205-4953
(480) 357-4400
(480) 807-0800
Mailing address
6104 E BROWN RD, SUITE 102, MESA, AZ 85205-4953
(480) 357-4400
(480) 807-0800
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
322
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
480032936
RR MEDICARE
AZ
01
—
480032937
RAILROAD MEDICARE
AZ
Enumeration date
08/17/2006
Last updated
04/23/2013
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