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General NPI Number Information
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NPI Number | 1093308983
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Entity Type | Organization
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Legal Business Name | WATER OAK FOOT AND ANKLE SURGERY
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Dates
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Enumeration Date | 02/11/2021
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 2270 MATLOCK RD STE 104
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City | MANSFIELD
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State | TX
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Zip | 76063-3710
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Country | US
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Telephone | 325-480-2063
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Fax | 702-514-6292
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Provider Business Mailing Address
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Address Line | 2270 MATLOCK RD STE 104
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City | MANSFIELD
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State | TX
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Zip | 76063-3710
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Country | US
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Telephone | 325-480-2063
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Fax | 702-514-6292
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTHEW MCCABE
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Credential | DPM
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Telephone | 702-630-1905
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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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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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