Healthcare Provider Details

I. General information

NPI: 1538562038
Provider Name (Legal Business Name): EAST TEXAS FOOT AND ANKLE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9209 STONEBANK XING
TYLER TX
75703-0829
US

IV. Provider business mailing address

9209 STONEBANK XING
TYLER TX
75703-0829
US

V. Phone/Fax

Practice location:
  • Phone: 903-941-9247
  • Fax: 888-503-2519
Mailing address:
  • Phone: 903-941-9247
  • Fax: 888-503-2519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH ROBERT CRANDALL
Title or Position: OWNER
Credential: DPM
Phone: 903-941-9247