Healthcare Provider Details

I. General information

NPI: 1447438536
Provider Name (Legal Business Name): FOOTCARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 CHURCHILL DR STE 220
FLOWER MOUND TX
75022-2716
US

IV. Provider business mailing address

4333 N JOSEY LN STE 206
CARROLLTON TX
75010-4631
US

V. Phone/Fax

Practice location:
  • Phone: 972-691-3232
  • Fax: 972-939-1682
Mailing address:
  • Phone: 972-939-1757
  • Fax: 972-939-1682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: GARY C MASHIGIAN
Title or Position: OWNER
Credential: D.P.M.
Phone: 972-939-1757