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General NPI Number Information
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NPI Number | 1851602858
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Entity Type | Organization
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Legal Business Name | ADVANCED FOOT AND ANKLE ASSOCIATES PLLC
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Dates
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Enumeration Date | 06/24/2010
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 833 TOWNE CT
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City | SAGINAW
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State | TX
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Zip | 76179-1280
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Country | US
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Telephone | 817-400-2004
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Fax |
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Provider Business Mailing Address
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Address Line | 824 KENTUCKY DERBY LN
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City | FORT WORTH
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State | TX
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Zip | 76179-7322
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Country | US
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Telephone | 817-400-2004
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | RUSSELL PENDLETON
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Credential | D.P.M.
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Telephone | 817-400-2004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 1916
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License Number State | TX
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