Provider Demographics
NPI:1528131810
Name:TEXAS FOOT SPECIALIST INC
Entity type:Organization
Organization Name:TEXAS FOOT SPECIALIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MANGUM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:281-991-0600
Mailing Address - Street 1:6021 FAIRMONT PKWY
Mailing Address - Street 2:STE 130
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-4022
Mailing Address - Country:US
Mailing Address - Phone:281-991-0600
Mailing Address - Fax:281-991-0638
Practice Address - Street 1:6021 FAIRMONT PKWY
Practice Address - Street 2:STE 130
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-4022
Practice Address - Country:US
Practice Address - Phone:281-991-0600
Practice Address - Fax:281-991-0638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00G37PMedicare ID - Type Unspecified