Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 0001002 | AZ |
NPI | 1053817452 |
---|---|
Provider Name | Christopher Van Damme |
First Address | Phoenix, AZ 85021-8862 |
Second Address | Gilbert, AZ 85234-2969 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2018 |
Last Update Date | 19/07/2021 |