Organization
ADVANCED FOOT & ANKLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL G OLSEN DPM (OWNER)
(435) 586-2225
Entity
Organization
Contact information
Practice address
1811 W ROYAL HUNTE DR, SUITE 2, CEDAR CITY, UT 84720-8273
(435) 586-2225
(435) 867-1909
Mailing address
1811 W ROYAL HUNTE DR, SUITE 2, CEDAR CITY, UT 84720-8273
(435) 586-2225
(435) 867-1909
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
106765-0501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107005417101
IHC
UT
01
—
167286
DMBA
UT
05
—
528156882001
—
UT
01
—
52815688205001
BLUECROSS BLUESHIELD
UT
05
—
530941699001
—
UT
Enumeration date
11/07/2006
Last updated
04/20/2008
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