Healthcare Provider Details

I. General information

NPI: 1699690339
Provider Name (Legal Business Name): LEGACY FOOT & ANKLE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 CANUELA WAY
JUSTIN TX
76247-1856
US

IV. Provider business mailing address

1121 CANUELA WAY
JUSTIN TX
76247-1856
US

V. Phone/Fax

Practice location:
  • Phone: 208-420-4916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: BRENDEN BARTON
Title or Position: PODIATRIST
Credential: DPM
Phone: 208-420-4916