Organization
ANDERSON PODIATRY CENTER PC
Active
Other names
Poudre Valley Foot and Ankle Clinic PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES CHARLES ANDERSON DPM (OWNER)
(970) 484-4620
Entity
Organization
Contact information
Practice address
1355 RIVERSIDE AVE, SUITE C, FORT COLLINS, CO 80524-4368
(970) 484-4620
Mailing address
1355 RIVERSIDE AVE, SUITE C, FORT COLLINS, CO 80524-4368
(970) 484-4620
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
662
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04013090
—
CO
05
—
109240500
—
WY
01
—
4800195741
RR MEDICARE
CO
01
—
CJ4464
RR MEDICARE
WY
Enumeration date
04/26/2007
Last updated
10/27/2014
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