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General NPI Number Information
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NPI Number | 1922579267
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Entity Type | Organization
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Legal Business Name | PMC FOOT AND ANKLE CLINIC PA
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 128 VISION PARK BLVD STE 135
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City | SHENANDOAH
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State | TX
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Zip | 77384-3017
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Country | US
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Telephone | 832-585-1620
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Fax | 855-787-3211
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Provider Business Mailing Address
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Address Line | 128 VISION PARK BLVD STE 135
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City | SHENANDOAH
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State | TX
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Zip | 77384-3017
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Country | US
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Telephone | 832-585-1620
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Fax | 855-787-3211
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Authorized Official
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Title or Position | SURGEON
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Name | ERIC R BLANSON
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Credential | DPM
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Telephone | 832-585-1620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ER0200X
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Taxonomy Name | Radiology Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213ES0000X
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Taxonomy Name | Sports Medicine Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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