Healthcare Provider Details

I. General information

NPI: 1851562649
Provider Name (Legal Business Name): DALLAS FOOT AND ANKLE SPECIALISTS,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 GASTON AVE STE 402
DALLAS TX
75246-1804
US

IV. Provider business mailing address

3600 GASTON AVE STE 402
DALLAS TX
75246-1804
US

V. Phone/Fax

Practice location:
  • Phone: 214-832-4710
  • Fax:
Mailing address:
  • Phone: 214-832-4710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1568
License Number StateTX

VIII. Authorized Official

Name: DR. PETER BRIAN WOOD
Title or Position: PRESIDENT
Credential: DPM
Phone: 214-824-7100