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General NPI Number Information
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NPI Number | 1215396544
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Entity Type | Organization
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Legal Business Name | DIABETIC FOOT AND WOUND CENTERS, PA
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 02/15/2016
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Provider Practice Location Address
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Address Line | 2600 S LOOP W SUITE 155
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City | HOUSTON
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State | TX
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Zip | 77054-2653
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Country | US
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Telephone | 225-773-0853
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 S LOOP W SUITE 155
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City | HOUSTON
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State | TX
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Zip | 77054-2653
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. AMOL GUPTA
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Credential | MD
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Telephone | 832-269-0717
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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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