Healthcare Provider Details

I. General information

NPI: 1235286485
Provider Name (Legal Business Name): YOUR TOTAL FOOT CARE SPECIALIST PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23230 RED RIVER DR
KATY TX
77494-2046
US

IV. Provider business mailing address

23230 RED RIVER DR
KATY TX
77494-2046
US

V. Phone/Fax

Practice location:
  • Phone: 813-953-3382
  • Fax: 281-395-3496
Mailing address:
  • Phone: 281-395-3338
  • 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 Number1064
License Number StateTX

VIII. Authorized Official

Name: DR. JAMES M. JACOBS
Title or Position: OWNER
Credential: DPM
Phone: 281-395-3338