Provider Demographics
NPI:1700447166
Name:FAMILY FOOT AND ANKLE SPECIALISTS LLC
Entity Type:Organization
Organization Name:FAMILY FOOT AND ANKLE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANT
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:BURNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-687-7099
Mailing Address - Street 1:828 S 1040 W
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-4614
Mailing Address - Country:US
Mailing Address - Phone:801-980-9444
Mailing Address - Fax:801-224-5204
Practice Address - Street 1:828 S 1040 W
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-4614
Practice Address - Country:US
Practice Address - Phone:801-980-9444
Practice Address - Fax:801-224-5204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty