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General NPI Number Information
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NPI Number | 1982673455
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Entity Type | Organization
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Legal Business Name | CENTER FOR FOOT AND ANKLE SURGERY, PA
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 05/07/2014
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Provider Practice Location Address
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Address Line | 1015 E 32ND ST STE 204
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City | AUSTIN
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State | TX
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Zip | 78705-2707
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Country | US
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Telephone | 512-477-8853
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Fax | 512-477-2592
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Provider Business Mailing Address
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Address Line | P.O. BOX 4948
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City | AUSTIN
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State | TX
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Zip | 78765-4948
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Country | US
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Telephone | 512-477-8853
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Fax | 512-477-2592
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES JASON HUBBARD
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Credential | D.P.M.
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Telephone | 512-477-8853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | 1625
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License Number State | TX
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