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General NPI Number Information
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NPI Number | 1568504371
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Entity Type | Organization
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Legal Business Name | FOOT SPECIALISTS OF TYLER, PA
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 11/13/2009
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Provider Practice Location Address
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Address Line | 649 S BROADWAY AVE SUITE 2
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City | TYLER
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State | TX
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Zip | 75701-1602
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Country | US
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Telephone | 903-592-7200
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Fax | 903-592-7211
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Provider Business Mailing Address
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Address Line | 649 S BROADWAY AVE SUITE 2
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City | TYLER
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State | TX
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Zip | 75701-1602
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Country | US
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Telephone | 903-592-7200
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Fax | 903-592-7211
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES D RHODUS
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Credential | DPM
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Telephone | 903-592-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 1375
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License Number State | TX
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