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General NPI Number Information
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NPI Number | 1720464837
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Entity Type | Organization
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Legal Business Name | HOUSTON ADVANCED & MINIMALLY INVASIVE LOWER EXTREMITY CARE PLLC
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Dates
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Enumeration Date | 07/31/2015
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Last Update Date | 07/31/2015
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Provider Practice Location Address
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Address Line | 7777 SOUTHWEST FWY
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City | HOUSTON
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State | TX
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Zip | 77074-1802
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Country | US
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Telephone | 214-396-3936
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Fax | 214-378-4664
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Provider Business Mailing Address
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Address Line | PO BOX 674074
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City | DALLAS
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State | TX
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Zip | 75267-4074
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Country | US
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Telephone | 214-396-3936
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Fax | 214-378-4664
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MISS BRANDY KAY BARROW
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Credential |
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Telephone | 214-396-3936
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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 | 1576
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License Number State | TX
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