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General NPI Number Information
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NPI Number | 1427263938
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Entity Type | Organization
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Legal Business Name | AUSTIN PODIATRY PA
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 4100 DUVAL RD STE 2-102
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City | AUSTIN
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State | TX
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Zip | 78759-4273
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Country | US
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Telephone | 512-719-4545
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Fax | 512-719-5511
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Provider Business Mailing Address
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Address Line | 4100 DUVAL RD 2-102
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City | AUSTIN
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State | TX
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Zip | 78759
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Country | US
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Telephone | 512-719-4545
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Fax | 512-719-5511
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUSIE NELY SANTANNA
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Credential | DPM
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Telephone | 512-719-4545
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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 | DPM1258
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License Number State | TX
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