Organization Name: | FOOT AND SHOE, LLC |
NPI Number: | 1003176090 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DOUGLAS JAY GRIMM (MEMBER) |
Mailing Address: | 7700 Cat Hollow Dr Ste 102 Round Rock |
State: | TX US |
Postal Code: | 786815797 |
Phone Number: | 5127338600 |
Fax Number: | 5127338602 |
NPI Enumeration Date: | 05/23/2012 |
NPI Last Update Date: | 05/23/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 1514 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |