Healthcare Provider Details

I. General information

NPI: 1346628161
Provider Name (Legal Business Name): FULSHEAR FOOT AND ANKLE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7609 TIKI DR STE D
FULSHEAR TX
77441-1678
US

IV. Provider business mailing address

7609 TIKI DR STE D
FULSHEAR TX
77441-1678
US

V. Phone/Fax

Practice location:
  • Phone: 281-391-1212
  • Fax:
Mailing address:
  • Phone: 281-391-1212
  • Fax: 281-346-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MELISSA P HURWITZ
Title or Position: MANAGING MEMBER
Credential: DPM
Phone: 315-380-3530