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General NPI Number Information
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NPI Number | 1467958538
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Entity Type | Organization
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Legal Business Name | SAN ANTONIO FOOT AND ANKLE CENTER, LLC
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 11212 STATE HWY 151, MEDICAL PLAZA 1 STE. 370
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City | SAN ANTONIO
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State | TX
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Zip | 78251-4504
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Country | US
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Telephone | 210-664-4700
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Fax | 210-314-1771
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Provider Business Mailing Address
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Address Line | 11212 STATE HWY 151, MEDICAL PLAZA 1 STE. 370
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City | SAN ANTONIO
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State | TX
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Zip | 78251
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Country | US
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Telephone | 210-644-4700
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Fax | 210-314-1771
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Authorized Official
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Title or Position | OWNER
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Name | CAROLINE DIANE GAYNOR
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Credential | MD
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Telephone | 210-644-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 1909
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License Number State | TX
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