Organization
COLLINS FOOT & ANKLE CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TYLER LEWIS COLLINS D.P.M. (PODIATRIST)
(801) 273-0100
Entity
Organization
Contact information
Practice address
1377 E 3900 S, SUITE 100, SALT LAKE CITY, UT 84124-1476
(801) 273-0100
Mailing address
1377 E 3900 S, SUITE 100, SALT LAKE CITY, UT 84124-1476
(801) 273-0100
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
105502-0501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528132679000
—
UT
Enumeration date
12/01/2011
Last updated
12/01/2011
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