Healthcare Provider Details

I. General information

NPI: 1083922710
Provider Name (Legal Business Name): NORTH CENTRAL TEXAS PODIATRY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 S FM 51 103
DECATUR TX
76234-3642
US

IV. Provider business mailing address

1713 S FM 51 103
DECATUR TX
76234-3642
US

V. Phone/Fax

Practice location:
  • Phone: 940-627-6976
  • Fax: 940-627-3491
Mailing address:
  • Phone: 940-627-6976
  • Fax: 940-627-3491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1305
License Number StateTX

VIII. Authorized Official

Name: DR. BRIAN BRADFORD CARPENTER
Title or Position: OWNER
Credential: DPM
Phone: 940-627-6976