Individual
CRAIG KENYON UDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
14539 W INDIAN SCHOOL RD STE 880, GOODYEAR, AZ 85395-9279
(623) 248-4734
(623) 259-7006
Mailing address
14539 W INDIAN SCHOOL RD STE 880, GOODYEAR, AZ 85395-9279
(623) 248-4734
(623) 259-7006
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
0859
AZ
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
0859
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
270291
—
AZ
01
—
8154560001
MEDICARE DME
—
01
—
Z274188
MEDICARE PTAN
AZ
Enumeration date
05/02/2013
Last updated
06/04/2024
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