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General NPI Number Information
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NPI Number | 1851399893
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Entity Type | Organization
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Legal Business Name | BRAZOS FOOT AND ANKLE CLINIC P.A.
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1201 MEDICAL PLAZA CT
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City | GRANBURY
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State | TX
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Zip | 76048-5684
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Country | US
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Telephone | 817-578-8555
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Fax | 817-573-6234
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Provider Business Mailing Address
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Address Line | 1201 MEDICAL PLAZA CT
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City | GRANBURY
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State | TX
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Zip | 76048-5684
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Country | US
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Telephone | 817-578-8555
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Fax | 817-573-6234
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Authorized Official
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Title or Position | D.P.M.
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Name | MR. SHANNON RAY MUELLER
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Credential |
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Telephone | 817-578-8555
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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 |
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License Number State | TX
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