Provider Demographics
NPI:1124383666
Name:LONESTAR FOOT & ANKLE
Entity Type:Organization
Organization Name:LONESTAR FOOT & ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYME
Authorized Official - Middle Name:R
Authorized Official - Last Name:CORNWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:817-573-3338
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-245-9045
Mailing Address - Fax:254-245-9284
Practice Address - Street 1:1200 CRAWFORD AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2267
Practice Address - Country:US
Practice Address - Phone:817-573-3338
Practice Address - Fax:817-573-3368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1949213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty