Provider Demographics
NPI:1104357284
Name:MOSELEY FOOT AND ANKLE CLINIC PLLC
Entity Type:Organization
Organization Name:MOSELEY FOOT AND ANKLE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:ANNELL
Authorized Official - Last Name:MOSELEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:214-208-9697
Mailing Address - Street 1:2416 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-2303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2416 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-2303
Practice Address - Country:US
Practice Address - Phone:214-208-9697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2057213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty