Western Arizona Foot & Ankle

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

0390 Issued in AZ

Legal business name

WESTERN ARIZONA FOOT & ANKLE

Practice address

1980 Mesquite Ave
Suite 103
Lake Havasu City, AZ 86403-7713

Phone

(928) 680-4934

Fax

(928) 505-4416

NPI assigned

Aug 31, 2007

Organization subpart

No

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

Authorized official

Name

James Patrick Wilson, DPM

Title

Owner

Phone

(928) 680-4934

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1188518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191974400000",
    "number": "1356535405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1980 MESQUITE AVE",
            "address_2": "SUITE 103",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864037713",
            "telephone_number": "928-680-4934",
            "fax_number": "928-505-4416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1980 MESQUITE AVE",
            "address_2": "SUITE 103",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864037713",
            "telephone_number": "928-680-4934",
            "fax_number": "928-505-4416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN ARIZONA FOOT & ANKLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-31",
        "last_updated": "2007-10-10",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-680-4934",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "AZ",
            "license": "0390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Matthew James Wetzel
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• Foot & Ankle Surgery Podiatrist in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Foot & Ankle Surgery Podiatrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 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.