| NPI | 1639122708 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN GORDON WASH Owner 254-741-1824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2011-06-20 |