Provider Demographics
NPI:1497786750
Name:ESPENSEN, ERIC H (DPM)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:H
Last Name:ESPENSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6644 E CARONDELET DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2119
Mailing Address - Country:US
Mailing Address - Phone:520-886-9866
Mailing Address - Fax:
Practice Address - Street 1:1500 N CAMPBELL AVE
Practice Address - Street 2:ROOM 4402
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-5872
Practice Address - Country:US
Practice Address - Phone:520-626-1349
Practice Address - Fax:520-626-8140
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4419213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABE7798183OtherDEA
CAU090678Medicare UPIN