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General NPI Number Information
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NPI Number | 1396336129
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Entity Type | Organization
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Legal Business Name | FOOT CLINIC OF THE HIGH PLAINS PLLC
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Dates
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Enumeration Date | 02/03/2021
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 2100 FM 2590 STE 200
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City | CANYON
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State | TX
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Zip | 79015-1982
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Country | US
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Telephone | 806-656-5006
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Fax | 806-656-5008
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Provider Business Mailing Address
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Address Line | 2100 FM 2590 STE 200
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City | CANYON
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State | TX
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Zip | 79015-1982
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Country | US
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Telephone | 806-656-5006
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Fax | 806-656-5008
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL Q TRAN
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Credential | DPM
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Telephone | 806-656-5006
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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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