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General NPI Number Information
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NPI Number | 1891396834
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Entity Type | Organization
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Legal Business Name | SHINE FOOT AND ANKLE CENTER
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Dates
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Enumeration Date | 11/05/2020
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Last Update Date | 11/05/2020
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Provider Practice Location Address
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Address Line | 11614 FM 2244 RD STE 150
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City | AUSTIN
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State | TX
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Zip | 78738-5471
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Country | US
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Telephone | 512-705-7737
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Fax |
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Provider Business Mailing Address
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Address Line | 11614 FM 2244 RD STE 150
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City | AUSTIN
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State | TX
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Zip | 78738-5471
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DPM/OWNER
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Name | SHINE JOHN
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Credential | DPM
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Telephone | 512-705-7737
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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 |
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