Provider Demographics
NPI:1609308576
Name:ARTISAN FOOT AND ANKLE SPECIALIST
Entity Type:Organization
Organization Name:ARTISAN FOOT AND ANKLE SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:GLAZER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:949-272-0007
Mailing Address - Street 1:32565 B GOLDEN LANTERN STREET
Mailing Address - Street 2:PMB 341
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3261
Mailing Address - Country:US
Mailing Address - Phone:949-272-0007
Mailing Address - Fax:949-272-0006
Practice Address - Street 1:26800 CROWN VALLEY PKWY
Practice Address - Street 2:STE 420
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6384
Practice Address - Country:US
Practice Address - Phone:949-272-0007
Practice Address - Fax:949-272-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty