Provider Demographics
NPI:1093982035
Name:SOUTHEAST TEXAS FOOT AND ANKLE PA
Entity Type:Organization
Organization Name:SOUTHEAST TEXAS FOOT AND ANKLE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HETMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:713-667-1057
Mailing Address - Street 1:915 GESSNER RD STE 460
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2520
Mailing Address - Country:US
Mailing Address - Phone:713-667-1057
Mailing Address - Fax:713-464-5325
Practice Address - Street 1:915 GESSNER RD STE 460
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2520
Practice Address - Country:US
Practice Address - Phone:713-667-1057
Practice Address - Fax:713-464-5325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1238213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U52603Medicare UPIN