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General NPI Number Information
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NPI Number | 1114139730
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Entity Type | Organization
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Legal Business Name | ADVANCED FOOT & ANKLE CENTER OF TEXARKANA, P.A.
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 5606 SUMMERHILL RD
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City | TEXARKANA
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State | TX
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Zip | 75503-1819
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Country | US
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Telephone | 903-791-1222
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Fax | 903-791-8310
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Provider Business Mailing Address
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Address Line | 2801 RICHMOND RD # 62
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City | TEXARKANA
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State | TX
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Zip | 75503-2123
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Country | US
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Telephone | 903-791-1222
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Fax | 903-791-8310
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Authorized Official
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Title or Position | DOCTOR
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Name | PHILIP JOHN HAHN JR.
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Credential | DPM
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Telephone | 903-791-1222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 1134
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License Number State | TX
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