| NPI | 1881182129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON MCCREARY Owner 817-731-4279 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 1644) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 1644) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: TX 1644) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: TX 1644) | |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2023-11-20 |