Provider Demographics
NPI:1184119380
Name:CRISON FOOT CARE PLLC
Entity type:Organization
Organization Name:CRISON FOOT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GRETEL
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:CRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:801-839-8337
Mailing Address - Street 1:8734 S PIPER LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-1426
Mailing Address - Country:US
Mailing Address - Phone:801-839-8337
Mailing Address - Fax:
Practice Address - Street 1:3024 WEST 300 NORTH, STE C
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:UT
Practice Address - Zip Code:84015
Practice Address - Country:US
Practice Address - Phone:385-393-8224
Practice Address - Fax:385-393-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT95-2954480501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty