Provider Demographics
NPI:1346431889
Name:DIAGNOSTIC FOOT SPECIALISTS
Entity Type:Organization
Organization Name:DIAGNOSTIC FOOT SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEISTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:713-862-3338
Mailing Address - Street 1:1740 W 27TH ST
Mailing Address - Street 2:STE. 307
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1440
Mailing Address - Country:US
Mailing Address - Phone:713-862-3338
Mailing Address - Fax:713-862-8328
Practice Address - Street 1:2710 HOSPITAL DR
Practice Address - Street 2:STE. 115
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5701
Practice Address - Country:US
Practice Address - Phone:361-575-5222
Practice Address - Fax:361-579-1385
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIAGNOSTIC FOOT SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty