Provider Demographics
NPI:1558420687
Name:FOOT & ANKLE ASSOCIATES INC
Entity Type:Organization
Organization Name:FOOT & ANKLE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:505-982-0123
Mailing Address - Street 1:2019 GALISTEO ST STE K
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2159
Mailing Address - Country:US
Mailing Address - Phone:505-982-0123
Mailing Address - Fax:505-982-5714
Practice Address - Street 1:2019 GALISTEO ST STE K
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2159
Practice Address - Country:US
Practice Address - Phone:505-982-0123
Practice Address - Fax:505-982-5714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMS2159Medicaid
NMDB1437OtherRAILROAD MEDICARE
NMS2159Medicaid
NM0656560001Medicare NSC