Provider Demographics
NPI:1235512682
Name:PURPLE GATOR, LLC
Entity Type:Organization
Organization Name:PURPLE GATOR, LLC
Other - Org Name:HOUSTON FOOT AND ANKLE PROFESSIONAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SELBST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-930-0362
Mailing Address - Street 1:17115 RED OAK DR
Mailing Address - Street 2:SUITE 218
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2641
Mailing Address - Country:US
Mailing Address - Phone:832-930-0362
Mailing Address - Fax:830-779-4362
Practice Address - Street 1:17115 RED OAK DR
Practice Address - Street 2:SUITE 218
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2641
Practice Address - Country:US
Practice Address - Phone:832-930-0362
Practice Address - Fax:832-779-4362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2006213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty