Organization
ADVANCED PODIATRY OF SOUTHERN IDAHO, LLC
Active
Organization
ADVANCED PODIATRY OF SOUTHERN IDAHO, LLC
Active
Other names
Advanced Foot & Ankle
Organization subpart
No
Provider details
NPI number
Authorized official
TAWNA H GOULDING (ADMINISTRATOR)
(801) 475-5239
Entity
Organization
Contact information
Practice address
476 CHENEY DRIVE WEST, TWIN FALLS, ID 83301
(208) 731-6321
(801) 475-5286
Mailing address
6028 S RIDGELINE DRIVE, SUITE 101, OGDEN, UT 84405
(801) 475-5239
(801) 475-5286
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
8015238-0501
UT
Other
Enumeration date
05/14/2012
Last updated
07/06/2012
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