Healthcare Provider Details

I. General information

NPI: 1962708792
Provider Name (Legal Business Name): ARLINGTON MANSFIELD FOOT & ANKLE CENTERS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MATLOCK RD STE 103
MANSFIELD TX
76063
US

IV. Provider business mailing address

400 W ARBROOK BLVD SUITE 201
ARLINGTON TX
76014-3174
US

V. Phone/Fax

Practice location:
  • Phone: 817-467-1990
  • Fax:
Mailing address:
  • Phone: 817-467-1990
  • Fax: 817-466-8737

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: JOE SOUTHERLAND
Title or Position: DPM/OWNER
Credential: DPM
Phone: 817-467-1990