Spectrum Falls Foot & Ankle Specialists, PC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

0484 Issued in AZ

Legal business name

SPECTRUM FALLS FOOT & ANKLE SPECIALISTS, PC

Practice address

2730 S Val Vista Dr
Suite 158
Gilbert, AZ 85296-6675

Phone

(480) 889-7055

Fax

(480) 889-7054

NPI assigned

Feb 24, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Clark J Fullmer II, DPM

Title

Physician

Phone

(480) 889-7055

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197504000000",
    "number": "1053447243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2730 S VAL VISTA DR",
            "address_2": "SUITE 158",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852966675",
            "telephone_number": "480-889-7055",
            "fax_number": "480-889-7054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2730 S VAL VISTA DR",
            "address_2": "SUITE 158",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852966675",
            "telephone_number": "480-889-7055",
            "fax_number": "480-889-7054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM FALLS FOOT & ANKLE SPECIALISTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-24",
        "last_updated": "2007-12-13",
        "status": "A",
        "authorized_official_last_name": "FULLMER",
        "authorized_official_first_name": "CLARK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "480-889-7055",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "AZ",
            "license": "0484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.