=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053627273
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH TEXAS FOOT AND ANKLE SPECIALISTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2010
-----------------------------------------------------
Last Update Date | 02/27/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 N LOCUST ST # 102
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-382-8801
-----------------------------------------------------
Fax | 940-382-8805
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 N LOCUST ST # 102
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-382-8801
-----------------------------------------------------
Fax | 940-382-8805
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TU A DAO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-585-3642
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP1100X
-----------------------------------------------------
Taxonomy Name | Podiatric Clinic/Center
-----------------------------------------------------
License Number | 1846
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------