Healthcare Provider Details

I. General information

NPI: 1710276662
Provider Name (Legal Business Name): EAST TEXAS FOOT AND ANKLE CENTERS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 10/09/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6603 OAK HILL BLVD
TYLER TX
75703-0586
US

IV. Provider business mailing address

6603 OAK HILL BLVD
TYLER TX
75703-0586
US

V. Phone/Fax

Practice location:
  • Phone: 903-939-3668
  • Fax: 903-939-0661
Mailing address:
  • Phone: 903-939-3668
  • Fax: 903-939-0661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1927
License Number StateTX

VIII. Authorized Official

Name: DR. JAMES EDWARD KENT
Title or Position: PODIATRIST
Credential: DPM
Phone: 903-939-3668