Provider Demographics
NPI:1720267065
Name:DFW FOOT AND ANKLE, PA
Entity type:Organization
Organization Name:DFW FOOT AND ANKLE, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVEY
Authorized Official - Middle Name:PASCHAEL
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-899-2170
Mailing Address - Street 1:2281 OLYMPIA DR.
Mailing Address - Street 2:#200
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028
Mailing Address - Country:US
Mailing Address - Phone:972-899-2170
Mailing Address - Fax:972-899-2171
Practice Address - Street 1:2281 OLYMPIA DRIVE
Practice Address - Street 2:#200
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028
Practice Address - Country:US
Practice Address - Phone:972-899-2170
Practice Address - Fax:972-899-2171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1581213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148292901Medicaid
TX00292TMedicare PIN
TX4661350002Medicare NSC
TX148292901Medicaid