| Organization Name: | FOOT CLINIC OF EAST TEXAS PC |
| NPI Number: | 1407142276 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT D PHELPS (OWNER) |
| Mailing Address: | 115 S Barron St Rusk |
| State: | TX US |
| Postal Code: | 757851253 |
| Phone Number: | 9035930987 |
| Fax Number: | 9035975618 |
| NPI Enumeration Date: | 06/21/2011 |
| NPI Last Update Date: | 05/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 1636 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |