Healthcare Provider Details

I. General information

NPI: 1932579216
Provider Name (Legal Business Name): TRINITY FOOT & ANKLE SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 OAKBEND TRL SUITE 140
FORT WORTH TX
76132-3912
US

IV. Provider business mailing address

5801 OAKBEND TRL SUITE 140
FORT WORTH TX
76132-3912
US

V. Phone/Fax

Practice location:
  • Phone: 817-377-3668
  • Fax:
Mailing address:
  • Phone: 817-377-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GLEN ALAN BEEDE
Title or Position: OWNER
Credential: DPM
Phone: 817-763-9383