Healthcare Provider Details

I. General information

NPI: 1508278623
Provider Name (Legal Business Name): AUSTIN FOOT & ANKLE CONSULTANTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 JAMES CASEY ST BLDG. F, STE. 100
AUSTIN TX
78745-1116
US

IV. Provider business mailing address

PO BOX 49547
AUSTIN TX
78765-9547
US

V. Phone/Fax

Practice location:
  • Phone: 512-649-3166
  • Fax: 877-528-6642
Mailing address:
  • Phone: 512-649-3166
  • Fax: 877-528-6642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1937
License Number StateTX

VIII. Authorized Official

Name: DR. JOSE ARNALDO RIVERA
Title or Position: DIRECTOR
Credential: D.P.M
Phone: 512-649-3166