Provider Demographics
NPI:1558388264
Name:SHARON QUACH DPM PC
Entity Type:Organization
Organization Name:SHARON QUACH DPM PC
Other - Org Name:ADVANCED FOOT AND ANKLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:TRAN
Authorized Official - Last Name:QUACH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:303-469-9292
Mailing Address - Street 1:12201 PECOS ST
Mailing Address - Street 2:SUITE # 400
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3888
Mailing Address - Country:US
Mailing Address - Phone:303-469-9292
Mailing Address - Fax:303-438-8951
Practice Address - Street 1:12201 PECOS ST
Practice Address - Street 2:SUITE # 400
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-3888
Practice Address - Country:US
Practice Address - Phone:303-469-9292
Practice Address - Fax:303-438-8951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO651213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1558388264OtherNPI
CO653789001OtherDME
COC0A107154OtherMEMORIAL PIN
COP00636035OtherMEDICARE RR
CO1801844519OtherTRICARE
CO80405762OtherMEDICAID ID
CO653789001OtherDME
V09914Medicare UPIN