Provider Demographics
NPI:1366859423
Name:THOMAS FOOT AND ANKLE PLLC
Entity Type:Organization
Organization Name:THOMAS FOOT AND ANKLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-943-6200
Mailing Address - Street 1:5300 N GRAND BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5647
Mailing Address - Country:US
Mailing Address - Phone:405-943-6200
Mailing Address - Fax:405-943-0080
Practice Address - Street 1:5300 N GRAND BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5647
Practice Address - Country:US
Practice Address - Phone:405-943-6200
Practice Address - Fax:405-943-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK215213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$OtherSTATE SSN