Healthcare Provider Details

I. General information

NPI: 1417446642
Provider Name (Legal Business Name): SOUTH ALAMO FOOT & ANKLE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PALO ALTO RD STE 133
SAN ANTONIO TX
78211-3792
US

IV. Provider business mailing address

102 PALO ALTO RD STE 133
SAN ANTONIO TX
78211-3792
US

V. Phone/Fax

Practice location:
  • Phone: 210-923-9200
  • Fax: 210-923-9202
Mailing address:
  • Phone: 210-923-9200
  • Fax: 210-923-9202

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: KRIS ALLEN FORD
Title or Position: OWNER
Credential: DPM
Phone: 210-227-8700