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General NPI Number Information
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NPI Number | 1164017703
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Entity Type | Organization
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Legal Business Name | FOOT & ANKLE SPECIALISTS OF CORPUS CHRISTI PLLC
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Dates
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Enumeration Date | 03/05/2021
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Last Update Date | 03/05/2021
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Provider Practice Location Address
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Address Line | 505 HOUSTON ST
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City | PORTLAND
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State | TX
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Zip | 78374-1645
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Country | US
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Telephone | 361-977-2035
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Fax | 361-977-2038
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Provider Business Mailing Address
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Address Line | 505 HOUSTON ST
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City | PORTLAND
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State | TX
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Zip | 78374-1645
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Country | US
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Telephone | 361-977-2035
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Fax | 361-977-2038
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | COREY MICHAEL GOOLSBY
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Credential |
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Telephone | 361-977-2035
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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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