Organization
PRESCOTT FOOT & ANKLE CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENT L PETERSON DPM (OWNER)
(928) 776-0770
Entity
Organization
Contact information
Practice address
919 12TH PLACE, SUITE 10, PRESCOTT, AZ 86305-1433
(928) 776-0770
(928) 776-8991
Mailing address
919 12TH PLACE, SUITE 10, PRESCOTT, AZ 86305-1433
(928) 776-0770
(928) 776-8991
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
0261AZ
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
700634
—
AZ
Enumeration date
11/08/2006
Last updated
02/08/2008
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