Healthcare Provider Details

I. General information

NPI: 1215373618
Provider Name (Legal Business Name): PHILLIP DAVID APPLEGATE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24022 CINCO VILLAGE CENTER BLVD STE 240
KATY TX
77494-3393
US

IV. Provider business mailing address

24022 CINCO VILLAGE CENTER BLVD STE 240
KATY TX
77494-3393
US

V. Phone/Fax

Practice location:
  • Phone: 832-376-8600
  • Fax: 832-376-8686
Mailing address:
  • Phone: 832-376-8600
  • Fax: 832-376-8686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number2188
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: