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General NPI Number Information
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NPI Number | 1912977729
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Entity Type | Organization
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Legal Business Name | FEET FIRST PODIATRIC CARE PA
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 422 N GENERAL MCMULLEN STE 102
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City | SAN ANTONIO
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State | TX
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Zip | 78237-1572
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Country | US
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Telephone | 210-431-9060
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Fax | 210-431-9660
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Provider Business Mailing Address
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Address Line | PO BOX 270504
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City | FLOWER MOUND
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State | TX
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Zip | 75027-0504
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Country | US
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Telephone | 972-874-0116
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Fax | 972-874-0206
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEVEN RICHARD FREDETTE
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Credential | DPM
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Telephone | 210-431-9060
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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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