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General NPI Number Information
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NPI Number | 1003606682
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Entity Type | Organization
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Legal Business Name | FOOT AND ANKLE SPECIALISTS OF GREEN COUNTRY
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 11348 251ST ST
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City | BEGGS
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State | OK
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Zip | 74421-2354
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Country | US
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Telephone | 918-852-2642
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 334
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City | GLENPOOL
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State | OK
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Zip | 74033-0334
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Country | US
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Telephone | 918-852-2642
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RUBEN DELACRUZ
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Credential | D.P.M.
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Telephone | 918-852-2642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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