| NPI | 1902171275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM ERIC PACK Owner 936-760-1200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 1243) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 1243) |
| 261QP1100X Clinic/Center, Podiatric | |
| Enumeration Date | 2012-03-19 |
| Last Update Date | 2025-01-20 |