Provider Demographics
NPI:1164890562
Name:FREE FOOT DOCTOR.COM
Entity Type:Organization
Organization Name:FREE FOOT DOCTOR.COM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VIC PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-850-0301
Mailing Address - Street 1:24914 TOMBALL PKWY STE 180
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-5080
Mailing Address - Country:US
Mailing Address - Phone:281-850-0301
Mailing Address - Fax:281-516-0066
Practice Address - Street 1:24914 TOMBALL PKWY STE 180
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-5080
Practice Address - Country:US
Practice Address - Phone:281-850-0301
Practice Address - Fax:281-516-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX1520213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty