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General NPI Number Information
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NPI Number | 1164890562
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Entity Type | Organization
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Legal Business Name | FREE FOOT DOCTOR.COM
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Dates
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Enumeration Date | 09/02/2015
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Last Update Date | 09/02/2015
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Provider Practice Location Address
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Address Line | 24914 TOMBALL PKWY STE 180
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City | TOMBALL
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State | TX
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Zip | 77375-5080
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Country | US
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Telephone | 281-850-0301
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Fax | 281-516-0066
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Provider Business Mailing Address
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Address Line | 24914 TOMBALL PKWY STE 180
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City | TOMBALL
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State | TX
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Zip | 77375-5080
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Country | US
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Telephone | 281-850-0301
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Fax | 281-516-0066
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Authorized Official
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Title or Position | VIC PRESIDENT
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Name | RONALD WILSON
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Credential |
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Telephone | 281-850-0301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | TX1520
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License Number State | TX
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