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General NPI Number Information
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NPI Number | 1710181011
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Entity Type | Organization
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Legal Business Name | GULF COAST FOOT CLINIC PA
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 03/19/2012
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Provider Practice Location Address
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Address Line | 815 N VIRGINIA ST
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City | PORT LAVACA
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State | TX
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Zip | 77979-3025
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Country | US
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Telephone | 361-552-0295
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Fax | 361-582-0615
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Provider Business Mailing Address
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Address Line | PO BOX 125
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City | PORT LAVACA
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State | TX
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Zip | 77979-0125
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Country | US
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Telephone | 361-552-0295
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Fax | 866-813-3644
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Authorized Official
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Title or Position | PODIATRY
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Name | DR. RICHARD STEINBERG
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Credential | D.P.M.
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Telephone | 361-552-0295
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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 | 1296
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License Number State | TX
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