MEDICARE: S & S FOOT SPECIALISTS, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist
2	213ES0103X	Foot & Ankle Surgery Podiatrist	TX1036	TX
3	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1679740401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S & S FOOT SPECIALISTS, PA

Provider Business Mailing Address
First Line	:	PO BOX 58508
Second Line	:
City	:	WEBSTER
State	:	TX
Zip	:	77598-8508
Country	:	US
Telephone Number	:	979-297-8500
Fax Number	:	979-297-3027

Provider Business Practice Location Address
First Line	:	121 HIGHWAY 332 W STE G
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-4099
Country	:	US
Telephone Number	:	979-297-8500
Fax Number	:	979-297-3027

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MOHAMMAD J BABA
Credential	:	MD
Telephone Number	:	979-297-8500

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	08/09/2021

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Directions to “S & S FOOT SPECIALISTS, PA ” Practice Location

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