Healthcare Provider Details

I. General information

NPI: 1750160461
Provider Name (Legal Business Name): LONE STAR FOOT AND ANKLE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 PARKWAY BLVD
SUGAR LAND TX
77478-3425
US

IV. Provider business mailing address

1602 PARKWAY BLVD
SUGAR LAND TX
77478-3425
US

V. Phone/Fax

Practice location:
  • Phone: 832-466-5888
  • Fax:
Mailing address:
  • Phone: 713-979-3343
  • Fax: 855-592-3269

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: DR. MATTHEW IVEY
Title or Position: PODIATRIST
Credential: DPM
Phone: 832-466-8588