Provider Demographics
NPI:1629962808
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:CMO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:REYZELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
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:415-645-4525
Mailing Address - Fax:
Practice Address - Street 1:5757 W THUNDERBIRD RD STE E-159
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4641
Practice Address - Country:US
Practice Address - Phone:480-844-8218
Practice Address - Fax:480-844-9950
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESERT FOOT & ANKLE P C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-04
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies