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General NPI Number Information
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NPI Number | 1689859027
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Entity Type | Organization
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Legal Business Name | PAN ACEA FOOT CENTER, P.A.
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 9896 BELLAIRE BLVD STE H
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City | HOUSTON
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State | TX
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Zip | 77036-3496
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Country | US
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Telephone | 713-270-8682
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Fax |
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Provider Business Mailing Address
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Address Line | 9896 BELLAIRE BLVD STE H
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City | HOUSTON
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State | TX
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Zip | 77036-3496
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Country | US
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Telephone | 713-270-8682
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SIMON T PAN
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Credential | M.D.
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Telephone | 713-270-8682
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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 | 1402
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License Number State | TX
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