Provider Demographics
NPI:1548778749
Name:PINNACLE FOOT AND ANKLE SPECIALISTS
Entity Type:Organization
Organization Name:PINNACLE FOOT AND ANKLE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:JESPERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:480-298-7882
Mailing Address - Street 1:879 N HARMONY AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-8020
Mailing Address - Country:US
Mailing Address - Phone:480-298-7882
Mailing Address - Fax:
Practice Address - Street 1:2730 S VAL VISTA DR STE 175
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1683
Practice Address - Country:US
Practice Address - Phone:480-298-7882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric