Provider Demographics
NPI:1639398183
Name:DESERT FOOT & ANKLE P C
Entity type:Organization
Organization Name:DESERT FOOT & ANKLE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCMO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:REYZELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:415-292-0638
Mailing Address - Street 1:PO BOX 32611
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0219
Mailing Address - Country:US
Mailing Address - Phone:480-844-8218
Mailing Address - Fax:480-844-9950
Practice Address - Street 1:1520 S DOBSON RD SUITE 312
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4700
Practice Address - Country:US
Practice Address - Phone:480-844-8218
Practice Address - Fax:480-844-9950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ77403Medicare PIN
AZU75953Medicare UPIN
AZ0358770001Medicare NSC
AZU70629Medicare UPIN
AZT41472Medicare UPIN
AZZ22745Medicare PIN
AZZWDBYRMedicare PIN