Provider Demographics
NPI:1417435082
Name:FORT WORTH FOOT AND ANKLE, PLLC
Entity Type:Organization
Organization Name:FORT WORTH FOOT AND ANKLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:713-417-4396
Mailing Address - Street 1:1307 8TH AVE STE 407
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4107
Mailing Address - Country:US
Mailing Address - Phone:817-776-5533
Mailing Address - Fax:
Practice Address - Street 1:1307 8TH AVE STE 407
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4107
Practice Address - Country:US
Practice Address - Phone:817-776-5533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-05
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty