Healthcare Provider Details

I. General information

NPI: 1093924433
Provider Name (Legal Business Name): NORTH TEXAS FOOT AND ANKLE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 N GLENBROOK DR
GARLAND TX
75040-4125
US

IV. Provider business mailing address

2020 N GLENBROOK DR
GARLAND TX
75040-4125
US

V. Phone/Fax

Practice location:
  • Phone: 972-530-3000
  • Fax: 214-369-6259
Mailing address:
  • Phone: 972-530-3000
  • Fax: 214-369-6259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1516
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1516
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateTX

VIII. Authorized Official

Name: MATTHEW JAMES HAUSENFLUKE
Title or Position: OWNER
Credential: DPM
Phone: 972-530-3000