Provider Demographics
NPI:1093221723
Name:SQUIRE FOOT AND ANKLE PLLC
Entity Type:Organization
Organization Name:SQUIRE FOOT AND ANKLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SQUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:928-457-0961
Mailing Address - Street 1:932 S MAIN ST UNIT B203
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-5585
Mailing Address - Country:US
Mailing Address - Phone:928-457-0961
Mailing Address - Fax:928-457-0929
Practice Address - Street 1:932 S MAIN ST UNIT B203
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5585
Practice Address - Country:US
Practice Address - Phone:928-414-1280
Practice Address - Fax:928-414-1280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ875213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty