Provider Demographics
NPI:1144085093
Name:PIONEER FOOT AND ANKLE, PLLC
Entity type:Organization
Organization Name:PIONEER FOOT AND ANKLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:BOWERBANK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:801-631-7997
Mailing Address - Street 1:3300 N RUNNING CREEK WAY
Mailing Address - Street 2:BUILDING C SUITE 300
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-3182
Mailing Address - Country:US
Mailing Address - Phone:801-901-4333
Mailing Address - Fax:801-901-4268
Practice Address - Street 1:3300 N RUNNING CREEK WAY
Practice Address - Street 2:BUILDING C SUITE 300
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043
Practice Address - Country:US
Practice Address - Phone:801-631-7997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty