Healthcare Provider Details

I. General information

NPI: 1740471283
Provider Name (Legal Business Name): DIAGNOSTIC FOOT SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 SOUTHWEST FWY STE. 295
SUGAR LAND TX
77478-3845
US

IV. Provider business mailing address

1740 W 27TH ST STE. 110
HOUSTON TX
77008-1440
US

V. Phone/Fax

Practice location:
  • Phone: 713-850-0125
  • Fax: 713-850-7176
Mailing address:
  • Phone: 713-862-3338
  • Fax: 713-862-8328

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: ROBERT LEISTEN
Title or Position: VICE PRESIDENT
Credential: DPM
Phone: 713-862-3338