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Foot Clinic Of East Texas Pc

Foot Clinic Of East Texas Pc is a health care provider in Tyler, TX. In this page you will find its mailing address, practice location, phone number, specialty etc.

physician-icon Basic Information

Practice Location 115 S Barron St, Rusk, TX 75785-1253, US
Practice Location Phone903-593-0987
Practice Location Fax903-597-5618
Legal Business NameFOOT CLINIC OF EAST TEXAS PC
NPI ?1407142276
Entity TypeOrganization
Enumeration Date ? Jun 21, 2011
Last Update Date ? May 10, 2012
Note:
NPI: National Provider Identifier issued to health care providers by Centers for Medicare and Medicaid Services (CMS).

specialty-icon Specialties & Licenses of Foot Clinic Of East Texas Pc

SpecialtySpecializationLicenseLicense State
PodiatristFoot & Ankle Surgery 1636Texas

legacy-id-icon Legacy Provider IDs of Foot Clinic Of East Texas Pc

Provider IdIssuer StateIssuer TypeIssuer
091707202TexasMedicaid
0095BVTexasMedicare Pin

official-icon Authorized Official of Foot Clinic Of East Texas Pc

An authorized official is an appointed official with the legal authority to make changes and/or updates to the Foot Clinic Of East Texas Pc's status and to commit the provider to fully abide by the laws and regulations relating to the National Provider Identifier (NPI).

Authorized Official Dr. Robert D Phelps (DPM)
Authorized Official Title/PositionOWNER
Authorized Official Phone Number903-593-0987