Healthcare Provider Details

I. General information

NPI: 1427263938
Provider Name (Legal Business Name): AUSTIN PODIATRY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 DUVAL RD STE 2-102
AUSTIN TX
78759-4273
US

IV. Provider business mailing address

4100 DUVAL RD 2-102
AUSTIN TX
78759
US

V. Phone/Fax

Practice location:
  • Phone: 512-719-4545
  • Fax: 512-719-5511
Mailing address:
  • Phone: 512-719-4545
  • Fax: 512-719-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM1258
License Number StateTX

VIII. Authorized Official

Name: DR. SUSIE NELY SANTANNA
Title or Position: OWNER
Credential: DPM
Phone: 512-719-4545