Healthcare Provider Details

I. General information

NPI: 1760124796
Provider Name (Legal Business Name): HOU FOOT ANKLE PRO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 RICHMOND AVE
HOUSTON TX
77098-3604
US

IV. Provider business mailing address

700 W CLAY ST
HOUSTON TX
77019-4348
US

V. Phone/Fax

Practice location:
  • Phone: 832-930-0362
  • Fax: 832-779-4362
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRIAN H SELBST
Title or Position: PROVIDER
Credential: MD
Phone: 832-930-0362