Provider Demographics
NPI:1831281708
Name:SERVOLD, SALLY A (DPM)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:A
Last Name:SERVOLD
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:820 CASTLE VALLEY BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NEW CASTLE
Mailing Address - State:CO
Mailing Address - Zip Code:81647-9480
Mailing Address - Country:US
Mailing Address - Phone:970-928-9785
Mailing Address - Fax:970-928-0423
Practice Address - Street 1:820 CASTLE VALLEY BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:NEW CASTLE
Practice Address - State:CO
Practice Address - Zip Code:81647-9480
Practice Address - Country:US
Practice Address - Phone:970-928-9785
Practice Address - Fax:970-928-0423
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO0459213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0459OtherSTATE LIC
CO01004597Medicaid
COBS3531224OtherDEA
COBS3531224OtherDEA
CO0459OtherSTATE LIC