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General NPI Number Information
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NPI Number | 1932428000
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Entity Type | Organization
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Legal Business Name | OM FOOT AND ANKLE CORP
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Dates
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Enumeration Date | 05/27/2010
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Last Update Date | 03/17/2014
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Provider Practice Location Address
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Address Line | 7333 BARLITE BLVD SUITE 110
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City | SAN ANTONIO
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State | TX
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Zip | 78224-1320
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Country | US
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Telephone | 210-932-9221
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Fax | 210-572-9290
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Provider Business Mailing Address
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Address Line | PO BOX 40055
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City | SAN ANTONIO
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State | TX
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Zip | 78229-1055
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Country | US
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Telephone | 210-932-9221
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Fax | 210-572-9290
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Authorized Official
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Title or Position | ADMIN
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Name | MS. ANDREA LUGO
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Credential |
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Telephone | 210-932-9221
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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 | 1939
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License Number State | TX
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