Provider Demographics
NPI:1316404874
Name:COLORADO FOOTCARE, LLC
Entity Type:Organization
Organization Name:COLORADO FOOTCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:J
Authorized Official - Last Name:DORMISH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:303-525-7211
Mailing Address - Street 1:2270 S VAUGHN WAY APT 201
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1340
Mailing Address - Country:US
Mailing Address - Phone:303-525-7211
Mailing Address - Fax:
Practice Address - Street 1:2270 S VAUGHN WAY APT 201
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1340
Practice Address - Country:US
Practice Address - Phone:303-525-7211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty