Organization
SOLE FOOT AND ANKLE SPECIALISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAY C LARSON DPM (OWNER/PRESIDENT)
(602) 938-3600
Entity
Organization
Contact information
Practice address
5750 W THUNDERBIRD RD STE G700, GLENDALE, AZ 85306-4673
(602) 938-3600
(602) 938-0400
Mailing address
PO BOX 27514, TEMPE, AZ 85285-7514
(480) 967-6500
(480) 967-6540
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
0196
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
700064
—
AZ
Enumeration date
05/23/2007
Last updated
06/28/2021
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