Provider Demographics
NPI:1790904282
Name:ASSOCIATED FOOT & ANKLE SPECIALISTS PLC
Entity Type:Organization
Organization Name:ASSOCIATED FOOT & ANKLE SPECIALISTS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:J
Authorized Official - Last Name:TALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:602-274-4100
Mailing Address - Street 1:6707 N 19TH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-1104
Mailing Address - Country:US
Mailing Address - Phone:602-274-4100
Mailing Address - Fax:602-246-1565
Practice Address - Street 1:6707 N 19TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-1104
Practice Address - Country:US
Practice Address - Phone:602-274-4100
Practice Address - Fax:602-246-1565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0213213ES0103X
AZ0532213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ81360Medicare PIN